Welcome Home Residential Care for the Elderly

Type of visit: Required - 1 Year

At 9:00am, on 9/3/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Backup Administrator Edwin Ingan, announced who he was and the reason for the visit. Staff and LPA conducted a full tour of the facility. This facility is a single story residential home with four resident bedrooms (two are dual occupancy) and two full bathrooms (one is en-suite and one is for public/shared use). There is a living room, dining room, and a kitchen. The dining room has a piano for residents and visitors to enjoy. LPA noted a fireplace in the dining room, the Backup Administrator states it is not used. Access to the laundry room is through locked bi-fold doors for resident safety. Hazardous items kept in the garage are locked in cabinets for resident safety. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. The facility has wired smoke detectors in each room that are all working. The carbon monoxide detector is in the entry under the visitor log and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 1/7/2026. LPA tested facility hot water at 117.3°F, within regulation temperatures 105-120°F. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility has no obstructions in hallways, doorways or exits. Medications are locked in a medication cart. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records.LPA conducted a staff and resident file review. LPA and Backup Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the Backup Administrator.the state’s words, verbatim · CDSS document, Sep 3, 2026

Allegation investigated: Staff did not provide resident with appropriate sleeping accommodations.

Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA was greeted by staff whom called Administrator and Administrator arrived shortly after. LPA explained the purpose of the visit to Administrator Evelyn Florentino. LPA De Leon took a tour of the resident bedrooms, took video and photos of the bed working, requested records and interviewed Administrator at 10:55 am, staff at 11:01am, witnesses at 11:50am and 1:00pm and residents at 10:48am and 11:59am. On the allegation: Staff did not provide resident with appropriate sleeping accommodations. LPA De Leon reviewed 3 resident Admission Agreements which revealed the Admission Agreement Pg. 3 Basic Services section (b) Safe and Healthful accommodations 1. Comfortable bed and suitable bedroom furniture. Continued 9099-C Unsubstantiated LPA interviewed residents which revealed Resident 1 (R1) was admitted to the facility on 11/17/2024 and brought R1's own hospital bed that had been purchased in 2020 in Oregon years prior to move in. The lower section of the bed is not working properly and R1 feels the facility knows how to fix it and is just not fixing it for R1. LPA conducted interview with Administrator which revealed Resident 1 (R1) brought in R1's own bed at admissions. The bed is a hospital bed and is not working correctly, the knee parts motor is going out and it will not work to lift and lower the knee section of the bed at all times. Administrator called several local businesses to see if they could fix the bed but due to it not being purchased from those companies they can not service it. Administrator notified family that is was not working correctly and family said they would take care of it. The facility staff contacted the manufacturer of the bed and on speaker phone walked the staff and R1 thorough the steps to try to lower the knee section of the bed, the staff was able to get the bed lowered so it can be used properly but the knee section motor is going out so it works at times and then doesn't at times to lift and lower the knee section of the bed. The Administrator offered to purchase a new bed from BestCare Pharmacy but R1 does not want the facility to purchase a new bed, R1 wants R1's bed fixed. the facility will do whatever is needed to accommodate R1 unfortunately the bed will probably need to be replaced as it can not be fixed and R1's family is aware and working on their end to get a replacement that will satisfy R1. R1 does have appropriate sleeping accommodations at this time. LPA conducted interview with staff 2 (S2) which revealed the staff contacted the manufacture of the bed and went through the steps of trying to fix it on speaker phone, the staff was able to go under the bed and fix the knee part to lower so the bed can be used but the knee section motor is not working properly all the time so it gets stuck in the higher or lower positon of the knee section. The manufacturer said it could be the knee section motor is going out and will need to be replaced or a new bed purchased and the company can not do anything for R1. The staff offered a bed that is stored in the garage but R1 refused the bed, the staff said they could purchase a new one and R1 said no R1 wants R1's bed fixed. The facility is unable to make that happen after several phone calls to the manufacturer. S2 talked to R1 and said that if R1 wants R1 knees raised and the bed is not working they can place pillows or cushions to elevate R1's knees and feet but that is not what R1 wants, R1 wants the bed fixed. Continued 9099-C LPA interviewed Witness 1 (W1) that stated the facility did make contact about the bed and W1 was looking into a replacement bed with the Veterans Association (VA) as the VA is who purchased the original bed and will find out if they can replace it due to it not working properly. W1 said the facility is doing what they can to accommodate R1 and R1 does have a bed to sleep in, it is just not functioning how it should and R1 wants the bed fixed not replaced. W1 will talk to R1 and explain that it may just need to be replaced and is working with the VA to get a replacement if that is what is needed. W1 will work with the facility and R1 to get this taken care of. LPA interviewed Witness 2 (W2) and W2 stated the facility does accommodate Resident 2(R2), the staff are great and attentive to W2's needs and they do contact W2 if something is needed for R2. R2 is always dressed and ready for visits and appointments. R2 does have visitors regularly and all reports to W1 have been great at the facility. W2 does not have any issues or complaints with the facility. LPA interviewed Resident 2 (R2) which revealed the staff are wonderful, always take care of R2's needs and R2 has never had any issues or complaints with the facility. Based on the evidence R1 has a bed to accommodate R1 at this time, the bed knee lift and lower is not working properly at all times, R1 has refused a new bed and a bed that is in storage, The facility has contacted everyone possible to get the bed fixed and has not been able to find anyone that can fix it, the motor is warring out and eventually will stop working at some point, W1 is working on getting a replacement bed for R1 through the VA. LPA observed the bed knee area to be working properly at the time of the visit. The facility has tried to accommodate R1 in every way but R1 wants R1's bed fixed and does not want a used bed or a new bed therefore this allegation is deemed Unsubstantiated at this time. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Dec 19, 2025 · control 29-AS-20251216083206

Type of visit: Required - 1 Year

At 12:05pm, on 9/24/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee/Administrator Evelyn Florentino, announced who he was and the reason for the visit. Licensee/Administrator and LPA conducted a full tour of the facility. This facility is a single story residential home with four resident bedrooms (two are dual occupancy), two full bathrooms (one is on-suite and one is for public/shared use). There is a living room, dining room, and a kitchen. The dining room has a piano for residents and visitors to enjoy. LPA noted a fireplace in the dining room, the Administrator states is not used. Access to the laundry room is through locked bi-fold doors for resident safety. The garage is through a locked door also for resident safety. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy. The facility has wired smoke detectors in each room that are all working, the Great Western Alarm technician was actively testing the smoke detectors and alarm system during the LPA visit. The carbon monoxide detector is in the entry under the visitor log and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 1/14/2025. LPA tested facility hot water at 110*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean with no obstructions in hallways, doorways or exits. Medications are locked in a medication cart. (Continued on LIC809-C) Staff and client files are locked near the living room. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding 3 of 4 resident's medications managed by the facility not logged on the centrally stored medication record as required by Title 22 regulation. LPA conducted a staff and resident file review. LPA and Licensee/Administrator conducted a review of the annual care tool modules. Exit interview conducted, deficiency cited on LIC809-D page, report signed, appeal rights and report provided to Licensee/Administrator.the state’s words, verbatim · CDSS document, Sep 24, 2025

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 2:05 pm to conduct a 1-year annual visit to the facility above. LPA met Administrator Evelyn Florentino and Edwin Ingan and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Physical Plant & Environmental Safety: The facility has 4 bedrooms and 2 bathrooms, currently occupying 3 residents and employs 5 staff. The facility is clean, safe, and sanitary. LPA was authorized to enter and inspect facility. The facility has dual smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for residents comfort. The facility kitchen is clean, safe, and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked under kitchen and bathroom sinks. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard and front yard for client use with shade. The facility has telephone and internet service for resident use. Continued 809-C Continued from 809 Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 10/18/2025. The facility is approved for a capacity of 6 non-ambulatory of which 1 may be bedridden in bedroom #1, and Hospice approved for 6 residents. Staffing: The facility employes 4 staff and 1 Administrator. Staff records are kept confidential. LPA reviewed 3 staff files. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions on file. Administrator's Certificates expired on 07/15/2025. Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed 3 staff training records for 2024 Annual Training Requirements of 20 plus hours meeting 8 hours of dementia training, 4 hours of hospice care, postural supports and restricted health condition and 8 hours of other training to include ADL's, resident characteristics, emergency preparedness policy and procedures, infection control requirements, PPE and Quarterly Disaster Drills. Staff handling medications had required 8 hours of medication training. Trainer met the requirements to train staff. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Three files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Pre-Admission appraisals are conducted on perspective residents before accepting them into care. Continued 809-C Continued from 809-c Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. Food, snacks, and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Incidental Medical & Dental: The facility has a locked medication cart in the dining room. If needed facility assists family members in finding transportation to medical and dental appointments and may attend appointment if family cannot. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected medication cart a sampling amount of prescription and PRN medications with doctors’ orders. No medications labels were altered, and no medications were expired. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers were charged and last inspected 01/16/2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does not currently have any residents using oxygen. The facility has exiting door alarms for the safety of residents in care. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Oct 22, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 12:00 pm to conduct a 1 year annual visit to the facility above. LPA met Administrator Evelyn Florentino and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current infection Control Plan on file. The facility has a sign in and out note pad with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have tight fitting covers. Physical Plant & Environmental Safety: The facility is a 4 bedroom and 2 bathroom currently occupying 5 residents and employs 8 staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has dual smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked in garage or under locked bathroom sinks. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard and front yard for client use with shade. The facility has telephone and internet service for resident use. The facility provides resident with a shared tablet for access internet. Continued 809-C Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 10/18/2024. The facility is approved for a capacity of 6 Non- Ambulatory of which 1 may be bedridden in bedroom #1, and Hospice approved for 3 residents. Staffing: The facility employes 6 staff and 2 Administrators. Staff records are kept confidential. LPA reviewed 5 staff files. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions on file. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. Administrator's Certificates expired on 07/15/2023 and Administrator is currently pending renewal with CCL. LPA verified renewal on CCL website. Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed 5 staff training records for 2023 Annual Training Requirements of 20 plus hours meeting 8 hours of dementia training, 4 hours of hospice care, postural supports and restricted health condition and 8 hours of other training to include ADL's, resident characteristics, emergency preparedness policy and procedures, infection control requirements, PPE and Quarterly Disaster Drills. Staff handling medications had required 8 hours of medication training. Trainer met the requirements to train staff. Initial staff training was kept on file. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Five files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Pre-Admission appraisals are conducted on perspective residents before accepting them into care. The Facility does not handle cash resources for the residents in care. Facility does submit incident reports to the department when required. Continued 809-C Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical & Dental: The facility has a locked medication cart in the dining room. Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected medication cart for all prescription and PRN medications with Doctors orders. No medications labels were altered and no medications were expired. The facility has a locked box for refrigerated medications. In an evacuation medications will be placed in ice chest with ice packs to keep cold. The facility has a red sharps container for disposal of syringes. Administrator and 1 other staff take medications to the pharmacy for destruct. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers were charged and last inspected 01/26/2023. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does not currently have any residents using oxygen. The facility has 3 hospice resident in care. Hospice care plans are kept on file and up to date. The facility does not currently have any resident on Home Health services. The facility has exiting door alarms for the safety of residents in care. LPA conducted interviews with 2 staff an attempted 2 interviews with residents. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Oct 27, 2023