Zosing Care Home II

Type of visit: Case Management - Annual Continuation

LPA arrived unannounced to the facility to pick up some elements of the annual, LPA met with administrator Angelica Velazquez, and explained the purpose of the visit. Zosing Care home II is a Residential Care Facility for the Elderly, with a current current census is Five. fire clearance is for 6 bed, non-ambulatory only. LPA reviewed Home Health Care and Hospice care plans for 1 resident. Hospice Intitial Health assessment declares the resident needing assistance with repositioning, and denotes her status as bed bound. Observation by the LPA is that the resident is deeply asleep. Interview with the staff is that she has difficulty repositioning on her own for basic hygine and toileting tasks, and meets the definition as Bedridden. Facility is not fire cleared for bedridden at this time. the 602 dated 12/26/25, says the resident is nonambulatory, in bed some of the time. The facility Death certificates for 5 residents in the year of 2025. LPA is asking for the hospice death reporting information for each client to be sent the LPA by 1/30/26: hospice Admissions Agreement, Hospice Care Plan, Hospice Notes from the month of death, most recent Needs and Services Plan, MAR from the month of death, any incident reports from the month of death, any Service Notes for the month of death, any discharge summaries for the six months prior to death. 2 staff, 1 residents were interviewed. Citation was issued on following d-page, A copy of the report was read and given to staff. exit interview was condected.the state’s words, verbatim · CDSS document, Jan 15, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80020(a) · Plan of correction due date: Jan 16, 2026

80020 Fire Clearance (a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. Facility did not meet the requirement as evidenced by: LPA record review of the initial hospice assessment where a resident is described as needing repositioning services, interview with the staff who respond affirmatively that assistance with repositioning is necessary. The resident meets the definition of bedridden, while the facility is fire cleared for 6-non ambulatory, 0 bedridden. This presents a health and safety risks to a resident in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: No plan of correction, the facility has an application for a fire clearance reappraisal submitted to the department on 1/8/26. Fire dpt. will come out and give thier assessment. LPA is asking to be informed of the decision to make nessisary upgrades to the facility or evict the resident in a timely fashion after the assessment by the fire department or if otherwise decided. LPA should be sent regular status updates(monthly begining 2/15/25) until the decision is made.

Type of visit: Required - 1 Year

On 12/5/25, at 10:28am Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility, to conduct a annual inspection. Zosing Care Home II is a 6 capacity facility with a current census of 5, there are 4 nonambulatory adults and 1 bedridden. 1 client is on hospice care, 1 client recieves home health services, 2 clients have mild cognitive impairment concerns, 3 clients have dementia concerns. Physical plant was inspected, including but not limited to the kitchen, common areas, bathrooms, bedrooms, exterior and evacuation route. facility is clean, traffic areas are well lit and unobstructed. the kitchen had adequate food supply for 2 days perishable, 7 days nonperishable. Bathrooms have functional hardware, bedrooms have required furniture. evacuation route gate is a little swollen from the weather and binding to its post, LPA gave guidance that it should swing freely and latch closed on its own. fire extinguisher was dated 01/21/2025, the smoke/co alarm was functional. water temparture was measured within 105-120*f. 2 of 2 staff files were reviewed. They contained fingerprinting clearance, background clearance, additional training from the last year including additional topics related to the dementia concerns for an appropritte number of hours.]. Continued on C page. 5 of 5 Client files were reviewed, including but not limited to the, needs and services plans, recent medical assessments, 602's. documents are present and up to date. Admission agreements contain some terms that should be changed, 2 week notification of termination in the event of death isn't possible, admission agreement is terminated upon death by regulation, refunds should be explicitly issued for services not performed, basic services may continue for a maximum of 15 days after a residents death only if the personal property of the deceased does not get addressed with an arrangement for leaving the facility. administrator files were reviewed, including but not limited to the facility sketch, facility license, administrator certificate(one is out of date in its physical representation, sent for being processed by CAB some 2 months back), Liability and workers comp insurance, no P+I not holding cash, no secretary of state not an llc yet, Evacuation plan, infection control plan. Documents are present and up to date. 4 of 5 clients were interviewed. 2 staff were interviewed. No citations as part of this visit, a copy of the report was read and given to staff, an exit interview was held.the state’s words, verbatim · CDSS document, Dec 5, 2025

Type of visit: POC

Unannounced Plan of Correction 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. A brief interview was conducted with the facility designated Administrator at this time. Current census was 4 residents.. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 12/09/2024. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 12/09/2024: Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. Plan of Correction clearance letter was printed and a copy was provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 12/09/2024 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 4 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 were (3) residents diagnosed with dementia at this time. It was learned that there weren't any 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 prior 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 extinguishers were located throughout this facility and observed to have been annually reviewed by the local fire authority, Armor Fire Extinguisher Co., on 01/12/2024 and 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 (4) 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 Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 9, 2024