Inspection visit

Routine inspectionNovember 9, 2023

COLONIAL ACRES RESIDENTIAL CARE HOMELicense 01920066415 citations on this visit

15 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Adeliza Magallones, administrator, and informed the purpose of the visit. LPA also met with Celeste Olivarez, facility consultant, and staff, Mary Eileen Olivarez-Legados, Ethel David, Bonifacio Flores and Maria Dolores Floriza. Facility has Infection Control Plan that was submitted on June 30, 2022. LPA toured the facility inside out with Adeliza Magallones and Mary Eileen Olivarez-Legados. LPA inspected the kitchen, dining area, living/tv room, common areas, staff and laundry room. bathrooms, side and backyard. LPA randomly selected 5 residents rooms for inspection. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has 2 in 1 carbon monoxide detector that was tested and observed in operating condition. Hot water temperature in one of the common bathrooms was tested and measured at 119.2 degrees Fahrenheit. LPA reviewed 5 staff and 5 residents files, and interviewed 3 staff and 3 residents. Medications checked, and compared with records and doctor's orders. Facility does not handle residents' cash resources. The following updated/current documents were obtained on this same day: 1. LIC308 Designation of Facility Responsibility 2. Proof of $3M liability insurance coverage Administrator to submit the following updated documents by November 23, 2023 : 1. LIC500 Personnel Report 2. LIC601E Emergency Disaster Plan (9 pages) ......continued on 809C Page 2 The following deficiencies were observed and cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections (POCs) by plan of correction due dates, and any repeat violations within 12 month period may result in civil penalties. -at 11:04 am, medicines in the medicine box with broken lock in the refrigerator. -at 11:06 am, expired sour cream with mold. -at 11:19 am Albuterol inhaler solution in the drawer in one of residents rooms. -at 11:24 am, shave cream, shaver glucose lancets, ointment in another resident's room. -at 11:42 am unlocked utility room where bleach and cleaning supplies are kept. -at 11:52 am, unlocked storage in the backyard where bleach and other cleaning supplies are kept. -at 12:30 pm, LPA asked the administrator who stated they haven't conducted disaster drill since last year. -at 2:15 pm, S1's first aid certificate expired 6/05/23 -at 2:50 pm, S3 has no first aid training, no annual training record and no LIC503 Health Screening and TB test record on file -at 3:15 pm. S4 and S5's first aid certificate expired 11/26/21 -at 5:00 pm, R1's LIC602A Physician's Report indicated needs assistance with all ADLs. -at 5:20 pm, R3's LIC602A is over a year old -at 5:30 pm, 5 out of 5 residents' LIC625 AppraisalNeeds and Services Plan do have residents' representative signatures. -at 6:05 pm, R1 has order for 4 medications but facility does not have on hand. Medications filled on 2023 and dates started not recorded on LIC622 Centrally Stored Medication and Destruction Record. No doctor's order on file for half bed rails. Deficiencies and plan and proof of corrections were discussed with the administrator and Mary Eileen Olivarez-Legados. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.

Citations

15 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

1569.695(c)Type B
Based on interview and record review, the licensee did not comply with the section cited above for not conducting disaster drills which poses a potential safety risk to persons in care.
87303(e)(5)Type A
Based on observation, the licensee did not comply with the section cited above for the shower area in the 2 bathrooms with not non-skid mats or strips which pose an immediate safety and/or personal rights risk to persons in care.
87309(a)Type A
Based on observation, the licensee did not comply with the section cited above for unlocked utility room and storage where bleach and cleaning supplies are kept which pose an immediate health and safety risks to persons in care.
87411(c)(1)Type B
Based on record review, the licensee did not comply with the section cited above for S1, S4 and S5 expired first aid certificates which pose a potential safety and/or personal rights risk to persons in care.
87411(f)Type B
Based on record review, the licensee did not comply with the section cited above for S3 not having LIC503 Health Screening and TB test on file which pose a potential health risk to persons in care.
87463(c)Type B
Based on record review, the licensee did not comply with the section cited above in 5 out of 5 residents' LIC625 with no signatures of residents' responsible person; it's not clear whether or not the assessment been discussed which pose a potential personal rights risk to persons in care.
87465(a)(4)Type A
Based on record review, the licensee did not comply with the section cited above for facility not having the 4 medications for resident (R1) which were on the list of order which poses an immediate health risk to person in care.
87465(h)(1)(C)Type A
Based on observation, the licensee did not comply with the section cited above for mediications in the storage box with broken lock and Albuterol soltuon in one of ther residents' rooms which pose an immediate health, safety and/or personal rights risk to persons in care.
87506Type B
Based on record review, the licensee did not comply with the section cited above for R1's LIC622 not recording the dates medications were filled and started which pose a potential health, safety or personal rights risk to person in care.
87555(b)(8)Type A
Based on observation, the licensee did not comply with the section cited above for the expired sour cream which poses an immediate health risk to persons in care.
87608(a)(3)Type B
Based on record review, the licensee did not comply with the section cited above for not having doctor's order on R1's file for half bed rails which poses a potential safety and/or personal rights risks to person in care.
87615(a)(5)Type B
Based on record review, the licensee did not comply with the section cited above for R1 who is dependent on staff with all activities of daily living which poses a potential safety and/or personal rights risk to persons in care.
87705(c)(5)Type B
Based on record review, the licensee did not comply with the section cited above for R3's LIC602A over a year old which poses a potential health and/or personal rights risk to persons in care.
87705(f)(2)Type A
Based on observation, the licensee did not comply with the section cited above for shave cream, shaver, glucose lancets, and ointment unlocked in resident's room which pose an immediate safety and/or personal rights risk to persons in care.
1569.625(b)(2)Type B
Based on record review, the licensee did not comply with the section cited above for S3 not having the required annual training on file which poses/posed a potential safety and/orpersonal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the November 9, 2023 inspection of COLONIAL ACRES RESIDENTIAL CARE HOME?

This was a inspection inspection of COLONIAL ACRES RESIDENTIAL CARE HOME on November 9, 2023. 15 citations were issued: 6 Type A (serious) and 9 Type B.

Were any citations issued to COLONIAL ACRES RESIDENTIAL CARE HOME on November 9, 2023?

Yes, 15 citations were issued (6 Type A, 9 Type B). The first citation was for: "Based on interview and record review, the licensee did not comply with the section cited above for not conducting disast..."

What type of inspection was this?

This was a inspection inspection. inspection inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

Routine inspection·November 9, 2023