Inspection visit

Routine inspectionNovember 12, 2024

AMBASSADOR CARE HOMELicense 07920058216 citations on this visit

16 citations recorded

Inspector’s narrative

What the inspector wrote

On 11/12/2024 at 09:50am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Administrator, Bienvenido Espina, Caregiver , and explained the purpose of the visit. LPA spoke with Administrator, Raufat Ikharo, via telephone. LPA toured the facility with including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of four (4) bedrooms and three and one-half (3 1/2) bathrooms. Swimming pool in back yard is surround and locked with metal gate. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was not working. Residents’ bathrooms are equipped with grab bars. Carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 9/3/2024. First aid kit was observed to be complete. LPA reviewed four (4) staff files. Three (3) of four (4) were incomplete. LPA reviewed four (4) resident's files and all were incomplete. Continued on LIC809. Continued from LIC809. LPA observed the following deficiencies: At 9:45am, LPA observed trash located on left-side of facility which included a clothes hamper, chandelier, card board boxes, filled garbage bags, a chair, and other items. At 10:05am, LPA observed two (2) tubes of ointment on R1's chest of drawers. At 10:05am, LPA observed comet, glass cleaner, and stain/order remover sitting on bathroom counter in master bathroom. At 10:10am, LPA observed a slide bolt lock on exit door leading to back yard. At 10:10am, LPA observed the door leading to the back yard was broken. Door would not stay closed without the bolt lock. At 10:15am, LPA observed unlocked medicine cabinet in kitchen. Cabinet had pad lock but it was unlocked. At 10:17am, LPA observed patio screen off in den area. At 10:18am, LPA observed sticky trap sitting on kitchen counter with dead insects. LPA also observed several traps around the kitchen. At 10:20am, LPA observed Pine-Sol and Fabuloso in unlocked kitchen cabinet underneath sink. At 10:52am, LPA observed unlocked cabinet full of disinfectants and cleaning supplies in laundry area. LPA requested the following documents to be submitted to CCLD by 11/19/2024. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Continued on LIC809C. Continued from LIC809C. At 10:55am, LPA observed facility did not have a 7-day supply of non-perishables and 2-day of perishables. At 11:00am, LPA observed there was not any hot water coming out the faucet in the shared bathroom. At 11:30am, LPA observed during record review three (3) of four (4) resident files were missing the admission agreement. None had an appraisal needs and service plan or consent for medical treatment. At 11:35am, LPA observed R1 and R3 glucose was being checked by staff. At 11:40am, LPA observed during record review facility did not have a hospice care plan for R4. At 11:45am, LPA observed during record review facility did not have a health care plan for R2. At 11:55am, LPA observed during record review facility did not have a current and accurate medication list for the residents. At 12:00pm, LPA observed during record review two (2) of four (4) staff was missing first aid and one (1) staff was missing the health screening. At 12:30pm, LPA observed during record review that facility is not conducting fire drills. At 1:30pm, LPA observed during record review that facility had not requested an exception for pressure injury. *An immediate $500.00 civil penalty will be assessed on today's date for fire safety* Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due date, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.

Citations

16 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 observation and record review, the licensee did not comply with the section cited above in conducting quarterly fire drills which poses/posed a potential health, safety or personal rights risk to persons in care.
87303(a)Type B
Maintain facility in clean, safe, sanitary condition
Based on observation, the licensee did not comply with the section cited above in patio screen in den in repair, exit door to back yard in repair, refrigerator and freezer sanitary which poses/posed a potential health, safety or personal rights risk to persons in care.
87303(e)(2)Type B
Provide resident hot water for personal care
Based on observation, the licensee did not comply with the section cited above in having hot water in shared bathroom's faucet which poses/posed a potential health, safety or personal rights risk to persons in care.
87309(a)Type A
Ensure hazardous items are locked and not unattended
Based on observation, the licensee did not comply with the section cited above in having cleaners and disinfectants inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.
87412(a)Type B
Maintain required personnel records for staff
Based on observation and record review, the licensee did not comply with the section cited above in having all staff files complete which poses/posed a potential health, safety or personal rights risk to persons in care.
87465(e)Type B
Require physician order and label for PRN medication
Based on observation, interview, and record review, the licensee did not comply with the section cited above in having and accurate record for all medication maintained in each residents file which poses/posed a potential health, safety or personal rights risk to persons in care.
87465(h)(2)Type A
Store centrally held medications in locked secure place
Based on observation, the licensee did not comply with the section cited above in having medication inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.
87555(b)(26)Type B
Onsite food stock levels for nonperishables and perishables
Based on observation, the licensee did not comply with the section cited above in having a 7-day supply of non-perishables and 2-day perishable foods which poses/posed a potential health, safety or personal rights risk to persons in care.
87555(b)(27)Type B
Kitchen sanitation against contamination sources
Based on observation and record review, the licensee did not comply with the section cited above in having kitchen area clean of insects which poses/posed a potential health, safety or personal rights risk to persons in care.
87606(a)Type B
Based on observation and record review, the licensee did not comply with the section cited above in having all resident records complete which poses/posed a potential health, safety or personal rights risk to persons in care.
87609(b)(4)Type B
Agree in writing on agency and facility responsibilities
Based on observation and record review, the licensee did not comply with the section cited above in having a home health care plan for R2 which poses/posed a potential health, safety or personal rights risk to persons in care.
87615(a)(1)Type A
No stage 3 or 4 pressure injuries
Based on observation and record review, the licensee did not comply with the section cited above in requesting an exception for a prohibited health condition which poses an immediate health, safety or personal rights risk to persons in care.
87628(a)Type B
Allowing diabetic residents based on self-management ability
Based on observation, interview, and record review, the licensee did not comply with the section cited above in retaining residents that are able to perform his/her own glucose testing which poses/posed a potential health, safety or personal rights risk to persons in care.
87633(b)Type B
Facility must keep complete hospice care plan on file
Based on observation and record review, the licensee did not comply with the section cited above in having a hospice care plan maintained at the facility for R4 which poses/posed a potential health, safety or personal rights risk to persons in care.
87705(l)(6)Type A
Based on observation, the licensee did not comply with the section cited above in having a bolt lock on door leading to back yard which poses an immediate health, safety or personal rights risk to persons in care.
87307(d)(6)Type B
Passageways and stairways kept clear
Based on observation, the licensee did not comply with the section cited above in keeping passageway on left side of facility outside free of obstruction which poses/posed a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the November 12, 2024 inspection of AMBASSADOR CARE HOME?

This was an inspection of AMBASSADOR CARE HOME on November 12, 2024. 16 citations were issued: 4 Type A (serious) and 12 Type B.

Were any citations issued to AMBASSADOR CARE HOME on November 12, 2024?

Yes, 16 citations were issued (4 Type A, 12 Type B). The first citation was for: "Based on observation and record review, the licensee did not comply with the section cited above in conducting quarterly..."

What type of inspection was this?

This was an 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 July 27, 2026. If you believe any information is inaccurate, report it here.

Routine inspection·November 12, 2024