Zosing Care Home

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst, Noel Wolf Petersen arrived unannounced to the facility to conduct a case management to finish some elements of the annual inspection. LPA met with the administrator Angelica Velasquez to explain the purpose of the visit. Current census is 4 residents over 60, 4 nonambulatory. Status of the fire clearance updates, licensee called monday, not heard back yet. Licensee updated the LPA that the second home wanted to increase/bedridden hospice capacity as well. LPA gave guidance that a lic 200 making the requested changes and a facility sketch was needed to process the changes. LPA had a conversation about the reporting requirements, Licensee provided the death reports physically. with the staff and the administrator. 4 residents were interviewed. 3 awake and responding positively to questions about thier care, 1 asleep. LPA asked for death reporting documents by end of day 1/17/25 for the five resident's who have died from the last year: Hospice Admissions Agreement, Hospice Care Plan, Hospice Notes, Needs and Services Plans, MARs, Any incident reports, Any Service Notes, Any discharge summaries. No citations issued at this time. A copy the report, was given to the administrator. exit interview conducted.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived on 12/23/2025 to conduct an annual inspection. LPA met with the administrator Angelica Velasquez and administrator Gene Velasquez to explain the purpose of the visit. Zosing Care Home is a 6 capacity facility for adults aged 60+, there are 0 clients with restricted care, with a total census of 4, 0 ambulatory, 4 nonambulatory, and 0 bedridden. 2 clients on Hospice, 2 clients on home health. Physical Plant was inspected, including but not limited to the kitchen, bedrooms, bathrooms, common areas, storage areas, exteriors, and evacuation routes. Facility is clean, traffic areas are well lit and unobstructed. Kitchen has adequate storage for sharps, toxics, and medication. There is adequate food stored for 4 residents, 2 days of perishable foods, 7 days of non perishable foods. Medication against Mar was checked for 2 clients at random. 1 client's medication is filled out for future dispersals, administrator provided while in a rush to account for the mornings medication dispersal, the staff also filled out the pm dispersal section for 12/23/25. LPA gave guidance for the staff not to rush medication documentation. Bedrooms have required furniture and furnishings, including mattress encasements(rubber hospital type). Bathrooms hardware is functional, water measured at sink at 119.1 *F. Evacuation route gate swings freely, outside is free of obstructions. Continued on C Page. Client files were reviewed. admission agreement has unenforceable terms: Lpa gave guidance the admission agreement is always terminated on the death of the resident. the refund policy and termination policy on basic services should be reviewed and updated by the licensee. The safeguarded property forms are not filled out for 1 resident, needs and services plan not filled out for 2 residents. Licensee provided that the two residents are new, from within the last two weeks. 602's are up to date. Half rails should be ordered by physician and for repositioning purposes only. Hospice care plans are up to date, Home health plans are up to date. for one client, Home Heath Care plan says bed bound, Hospice nurse agrees with that estimation saying the client cannot support thier weight. While all the clients 602's reflect nonambulatory status, LPA has concerns related to the one clients ability to reposition themselves, given the 602, home health, and hospice care plans assessments for the resident. The Facility is licensed for 6 non-ambulatory, 2 may be on hospice. a Fire Clearance request for an update the license for expanding the hospice/bedridden allowable was made to LPA Charlie Yang via email 2/5/2025, and the request wasn't put though. LPA is asking the licensee to send in a new request; new facility sketch with the updated staff room and nonambulatory/bedridden room designations update for processing into an new LIC 850. The LPA notes there is a master bedroom with access to the outside world with ample space for 2 bedridden. The physical Plan Of Operation file submitted to licensing containing the original granted fire clearance 850, is unavailable for review. The facility does not have a copy of their most recent fire clearance for review. Given that all residents are declared non-ambulatory, and the facility has physical rooms for meeting needs of the current clients if they were to become bedridden, the immediate action by the licensee to get a new 850, and the unknown quality of the statements on the most recent 850, the LPA is not going to cite fire clearance at this time but schedule a follow up case management for after the fire inspection is completed. Staff records were reviewed, including a first aid/cpr, additional training and entry training, criminal background clearance and finger printing. Documents are up to date and present. Administrator files were reviewed, including facility posters, facility sketch, facility license, administrator certificate, and program design, infection control plan, evacuation plan. Documents are up to date and present. 2 residents were interviewed. 1 asleep, 1 nonverbal. 2 staff were interviewed. No citations issued, a copy of the report was read and given to the administrator. Exit interview.the state’s words, verbatim · CDSS document, Dec 23, 2025

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 01/23/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Angelica Velasquez, who was briefly interviewed at this time. Current census was 5 residents. It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (2) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there was (1) resident diagnosed with dementia at this time. It was learned that there were (2) residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located in a room adjacent to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6003830740, for Angelica Velasquez was observed to have an expiration date of 07/07/2025 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility living room closet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication closet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher that was located in the kitchen area was observed to have been annually inspected by the local fire extinguisher company, Jorgensen and Company, on 01/23/2025 and found to be in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (3) facility personnel records was conducted on the LIC 859. A review of (5) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated representative at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1 Year Inspection Visit. LPA met with administrator and explained the purpose of the visit. Administrator certificate #6003830740 expires on 7/7/2025. This facility is a single story building licensed to serve six (6) non-ambulatory residents and a hospice waiver for two residents. LPA and administrator toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 113.6 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers serviced 1/12/2024. Smoke and carbon monoxide detectors are in compliance with fire safety. Fire drill last conducted on 10/22/2023. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed three resident and three staff files, including criminal record clearances. LPA reviewed Fingerprint clearance and associations to the facility. First aid kit was checked and is complete. LPA requested the following forms to be submitted via email by February 6, 2024: LIC 308, Liability insurance Certificate, and Administrator Certificate. ruth.wallace@dss.ca.gov No deficiencies cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Exit interview held with Administrator. A copy of report and LIC 811(Confidential Names) given at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 17, 2024