Wholesome Elderly on Mathis

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with staff, Martha Szatmari and Fnu Jahanvi. Administrator, Juan Ramirez, arrived around 11:00 am. LPA observed (2) residents in the common area and (3) residents in their rooms. The facility is licensed for (3) bedridden residents, (3) non-ambulatory residents and for (6) hospice residents. Currently, there are (2) residents on hospice. A hospice nurse arrived at the end of the inspection. LPA and caregiver toured the interior/exterior of the facility, including the common areas, (2) shared resident rooms, (2) private resident rooms and staff room. LPA observed it to be clean, in good repair and odor free. All bathrooms have the necessary grab bars, skid-resistant flooring, trash cans and hygiene products. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen and additional toxins are secured in the laundry area. Medications are secured in the office. There are sufficient towels/blankets/linens on hand and a complete First Aid Kit. Inside temperature was 75*F, and hot water measured 108*F in the kitchen. Smoke/monoxide alarms are working and the fire extinguisher was last serviced on 11/25/25. Exit doors have auditory alerts, and there are no blockages to any doors. There is a back yard walking path, one unlocked exit gate, and covered seating. Required postings are in the common area. Annual fees due by May 3, 2026. Multiple topics discussed. LPA reviewed (3) resident and (4) staff files. Files were organized and contained the required documentation. Staff is completing ongoing required annual training, has current First Aid/CPR certifications and is cleared/associated. Medications were reviewed for (2) residents. Orders match medications being administered; there is an electronic medication record system. LPA obtained updated land line contact, and requested current insurance policy, LIC308 and LIC500 be provided by 3/27/26. There is (1) deficiency issued on the 809-D page. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 20, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection and met with staff, Jocelyn Cardenas, and Fnu Jahanvi, and stated the reason for today's inspection. LPA observed (1) resident in the common area and (5) residents resting in their rooms. LPA observed the refrigerator to not have a bicycle lock on the outside. LPA observed sufficient 2+day perishable food, including fruit, yogurt, pudding, grapes, sandwich meats, and lots of eggs, and a melon and tangerines on the counter. Staff stated a lock was temporarily placed on the fridge due to a resident (R1) grabbing frozen food and consuming it without cooking and another situation that occurred with (R3), who also has a diagnosis of Dementia. (R1) is not showing agitation since recent medication changes. LPA and staff also discussed a recent incident with resident (R2) who was sent out to the Emergency Room on 7/14/2025, due to displaying aggressive behaviors, including throwing medication, their phone, slamming doors and cursing, and causing the other residents to be scared. (R2) has been resting in their room since returning from the hospital this morning. LPA reviewed hospital discharge paperwork from July 8, 2025 when (R2) was initially sent out for aggressive outbursts and medication adjustments. An increased dosage of Seroquel 25 mg and 50 mg were prescribed on 7/8/2025. LPA spoke to the Administrator, Juan Ramirez, by phone during today's inspection. LPA advised that the refrigerator should not be locked and to ensure residents are getting full meals and to ensure snacks are offered at regular times. LPA was advised of the plan for (R2) and will reach out to a family member for a medical status update so that an appointment can be made with the appropriate medical and mental health care professionals. Also discussed how to issue a 30-day eviction notice if needed. There are no deficiencies issued in this report. Exit interview with staff. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Jocelyn Cardenas, staff, and stated the reason for today's inspection. LPA spoke to Juan Ramirez, Administrator, by phone, who arrived around 2:00 pm. LPA observed (2) residents in the common area and (3) residents in their rooms. The facility is licensed for (3) bedridden residents, (3) non-ambulatory residents and for (6) hospice residents. Currently, there is (1) resident on hospice. LPA and caregiver toured the interior and exterior of the facility. LPA observed it to be clean, in good repair and odor free. All bathrooms have the necessary grab bars, non-skid flooring and trash cans with lids. Hand-washing posters to be added at each sink. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen and additional toxins are secured in the laundry area. Medications are secured in the office, and there is a separate locked mini-refrigerator for medications. There are sufficient towels/blankets/linens on hand and a complete First Aid Kit.The inside temperature was 70*F. Fire extinguisher was last serviced on 9/4/2024, and doors have alarms. Administrator RCFE Certificate #6068264740- exp 1/29/26. There is a back yard walking path, one unlocked exit gate, and no pools. There is covered seating. Required postings are in the common area and visitor hours to be posted near the sign-in area at the entrance. LPA reviewed (2) resident files and (2) staff files. Files were organized and contained current paperwork. Staff is completing initial/ongoing required annual training and has current First Aid/CPR certifications. Staff is cleared and associated. Medications were reviewed for (1) resident, Orders match medications being administered, and there is an electronic medication record system. LPA obtained updated phone/email contacts, and requested current insurance policy, LIC308 and LIC500 be provided by 5/2/25. There are no deficiencies issued. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 25, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection and met with Assistant Administrator, Martha Szatmari, and caregiver, Fnu Jahanvi, and stated reason for the inspection. LPA was informed there are currently (5) residents living in the home and (1) resident is under hospice care. LPA observed all residents to be present during the inspection. LPA discussed the incident involving resident (R1) leaving the facility unattended on 10/12/24, at 10:00 am, with both staff present and with Administrator, Noel, by phone. Administrator Designee, Juan Ramirez, also called by phone to discuss the reason for today's inspection and the incident. Today's discussion revealed that (R1) was able to leave the care home through the back patio door and side gate, as the alarm was turned off on the door, and (R2) had left the gate open. Staff (S1) confirmed she was present at the time (R1) left, and she had no idea he went outside, as he was watching television in the common area after breakfast, and she was in an adjacent room. (S1) stated the police arrived at the care home around 10:30 am to request emergency papers for (R1) and to inform staff they would be taking him to the hospital after he was found to have fallen nearby, sustaining a lip laceration and scratches on his head. All interviews confirmed that (R1) had never attempted to leave the care home unattended before, and left because he was looking for his car. Medical documentation shows (R1) has a diagnosis of Dementia and cannot leave the facility unattended. Hospital paperwork shows (R1) was treated for a laceration of lip, head injury, has Dementia and was discharged on 10/12/24 (9:43 pm). The facility completed an incident report and emailed it to the regional office email on 10/22/24, which was inadvertently forwarded to another LPA. The assigned LPA did not receive the report until 11/13/24. The Administrator updated (R1's) care plan on 10/22/24 to reflect a change in mental status requiring resident to need closer supervision. An appointment will be scheduled today with (R1's) primary care physician to discuss any follow up needed. An updated physician's report will be requested again and a copy provided to the Department. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is issued. Exit interview with Assistant Administrator. Copy of report and appeal right given.the state’s words, verbatim · CDSS document, Nov 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4) · Plan of correction due date: Nov 18, 2024

87705 Care of Persons with Dementia.(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by: Based on interviews conducted, the Licensee did not ensure that resident (R1) was unable to leave the facility unassisted, on 10/12/2024, which posed an immediate health and safety risk to residents in care. The exit door alarm was not activated due to being turned off and has since been turned back on.the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: Licensee/Administrator agree to conduct staff training on AWOL prevention and protocols. Facility to submit documentation to LPA by fax by 11/29/24.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required post-licensing inspection and met with Martha Szatmari, caregiver, and stated reason for the inspection. LPA asked to speak to the Administrator. Caregiver called Noelle Estillore, Administrator, who indicated he was not able to attend the inspection since he was currently at another location. Caregiver then called Juan Ramirez, Co-Administrator. LPA spoke to Juan and stated the reason for todays inspection. Juan stated he was out of the area at this time and authorized caregiver, Martha, to act as Administrator Designee today, stating there is a signed LIC308 on file. LPA observed one to be on file The facility is approved for (6) non-ambulatory residents and has an approved hospice waiver for (6). There is (1) resident on hospice care. LPA and caregiver toured the interior and exterior of the facility. LPA observed it to be clean, in good repair and odor free. There were (2) residents in the common area and (3) residents in their rooms at the start of the inspection. All bathrooms have the necessary grab bars, non-skid flooring, and hand-washing posters. Administrator to place paper towels/holder in the front bathroom. There is sufficient 2+day perishable and 7+day non-perishable supply of food. Sharps are locked in the kitchen and toxins are locked in the kitchen and laundry area. Medications are secured in the office, and there is a separate locked mini-refrigerator for medications. Electronic medication system. The inside temperature was 74*F. Fire extinguisher was last serviced on 9/4/2024, and doors have alarms. LPA observed a complete First Aid kit. PPE and paper supplies. Required postings are in the common area. Administrator RCFE Certificate #6033614740- exp 2/9/25. There is a back yard walking path, one unlocked exit gate, and no pools. Resident and staff files are set up and organized. LPA reviewed (3) resident files and found them to contain current paperwork. (3) staff files were reviewed. Lead staff has current CPR certification. Infection Control Plan and Disaster plan on file- to be reviewed/signed at least annually. LPA interviewed staff and residents. Administrator to provide a copy of current liability insurance and staff initial/annual training, current First Aid/CPR certification for all staff to LPA by 9/27/24. There are no deficiencies issued in this report. Exit interview with authorized staff. Copy of report left at the facility.the state’s words, verbatim · CDSS document, Sep 20, 2024

Type of visit: Prelicensing

On 05/01/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Pre- Licensing visit. LPA met with Administrator, Chris Faamausili and explained the purpose of the visit. This application is a change in ownership (CHOW). The address is currently licensed as Elizabeth Care Homes IV, Facility #345002840. Administrator holds a current administrator certificate (#6039698740 with expiration date 06/08/24 ). The facility currently has five (5) residents during today's inspection. Facility has a fire clearance for 6 non- ambulatory residents. LPA and staff conducted a tour of the interior and exterior of the facility. Areas toured include but are not limited to: two (2) private resident bedrooms and two (2) shared resident bedrooms, bathrooms, kitchen, dining room, laundry room, and common areas. Bedrooms have appropriate furnishings. Grab bars were present in the bathroom. The facility has a food supply of, 2 days of perishable and 7 days of non-perishable food items. Smoke detectors and carbon monoxide detectors are present and operational. The Fire extinguisher was last serviced 09/15/23. All exits were unobstructed. All toxins, medications, and sharps were locked and inaccessible to residents in care. Facility's temperature was 75 degrees during todays inspection. Hot water temperature was observed to be 112.5 degrees Fahrenheit, which is within the regulation range of 105-120 degree. First aid kit present and maintained.LPA reviewed one (1) resident and one (1) staff file and found that all required paperwork was present. LPA did provide facility with LIC311F. Component III was waived as the current administrator has been administrator for other RCFEs licensed by CCLD. LPA will forward findings to the Centralized Application Bureau (CAB) that facility met all the pre-licensing components. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations on today's pre-licensing inspection. A copy of this report was left at the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, May 1, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 Interview Method: Telephone interview On 2/1/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 1, 2024