Inspection visit

Health checkFebruary 13, 2024

ANGEL CARE HOMELicense 07920113414 citations on this visit

14 citations recorded

Inspector’s narrative

What the inspector wrote

On 2/13/2024 at 12:20pm, Licensing Program Analyst (LPAs), L. Hall and T. Syess-Gibson arrived unannounced to conduct a health and safety check as a result of the department receiving a complaint (15-AS-20240212113726). LPAs met with Ding Wang, Administrator and explained the reason for the visit. During the health and safety check LPA toured the facility with the Administrator including but not limited to common areas, bedrooms, back yard, and kitchen. Upon arrival LPA observed S3 was not associated to the facility. A bottle of medicine was sitting on the table and the medicine cabinet was unlocked. The following deficiencies were observed during the check: At 9:40am, LPAs observed S3 was not associated and during record review that R3 was not fingerprint cleared. At 9:40am, LPAs observed medicines were in unlocked closet and there was a bottle of Tylenol sitting on the kitchen table. At 9:55am, LPAs observed unlocked kitchen drawer containing knives, a bottle of S2 medication in unlocked kitchen cabinet, and a pair of scissors sitting on kitchen counter top in utensil dryer. At 10:05am, LPAs observed rotting fruit sitting on kitchen table and rotting vegetables in refrigerator. Facility did not have a 7-day supply of non-perishables and 2-day of perishables for the residents. Continued on LIC809C. Continued from LIC809. 10:40am, LPAs observed R2, R3, and R4 resided in ambulatory rooms per fire clearance. At 10:45am, LPAs observed hot water temperature in residents' shared bathroom measured at 133.5 degrees F. and Ajax and Windex under unlocked bathroom cabinet. At 10:50am, LPAs observed via interview and record review S1 did not report any deaths, hospitalization's, or positive COVID incidents. At 10:50am, LPAs observed during via interview and record review that S1 did not notify CCLD of hospice residents. At 10:50am, LPAs observed facility did not obtain a hospice care plan for R3 and R4. At 10:50am, LPAs observed during record review that staff files were incomplete and not current. At 10:50am, LPAs observed during record review that resident files were incomplete and not current. At 11:00am, LPAs observed during record review that there were not any training records for staff in files. At 11:30am, LPAs observed during record review that the medication administration record (MAR) did not match the medications that were given to R2. MAR for R3 has not been updated since 2/3/2024. There was not a MAR for review for R4. At 11:40am, LPAs observed Administrator was not meeting the qualifications and duties of an Administrator as specified in the regulation 87405. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Continued on LIC809C. Continued from LIC809C. An immediate $2000.00 civil penalty will be assessed on today's date for the following: Exit interview conducted. A copy of the LIC421FC, LIC421M, LIC421BG, this report, and appeal rights provided

Citations

14 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.

87202(a)(1)Type A
87202(a) All facilities shall maintain a fire clearance approved by the city, county... department, or district providing fire protection services... Prior to accepting or retaining... licensee shall notify the licensing agency and obtain an appropriate fire clearance...(1) Non ambulatory persons.This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in have 3 non-ambulatory residents in ambulatory rooms, which poses a potential health and safety risk to persons in care.
87211(a)(1)Type B
87211 (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement was not met as evidence by: Based on interview and record review the Licensee did not comply with the section cited above in reporting incidents to CCLD, which poses a potential health and safety risk to persons in care.
87303(Type A
87303 (e)Water supplies and plumbing fixtures shall be maintained as follows: (2)Faucets used by residents... Hot water temperature controls shall be maintained... to attain a temperature of not less than 105 degree F and not more than 120 degree F. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in have hot water between 105-120, which poses/posed an immediate health and safety risk to persons in care.
87355(d)(3)Type A
87355 (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement... (3) The licensee shall submit these fingerprints... for the purpose of searching the records... prior to the individual's employment, residence, or initial presence in the facility. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having S3 fingerprinted before working at facility which poses a potential immediate health and safety risk to persons in care.
87411(c)Type B
87411 (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having annual training for staff, which poses a potential health and safety risk to persons in care.
87412(a)Type B
87412 Personnel Records(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having all personnel records complete and current, which poses a potential health and safety risk to persons in care.
87465(h)(2)Type A
87465 (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited in have medications locked and inaccessible, which poses/posed a potential health and safety risk to persons in care.
87465(h)(6)Type B
87465 (h) The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having the medication administrator record (MAR) current and aligned with resident's medication, which poses a potential health and safety risk to persons in care.
87506(a)Type B
87506 (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in have complete and current records for residents, which poses a potential health and safety risk to persons in care.
87555(b)(26)Type B
87555 (b) The following food service requirements shall apply: (26)Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidence by:Based on observation the Licensee did not comply with the section cited above in have 1 week perishable and 2-day non perishable foods for residents, which poses a potential health and safety risk to persons in care
87632Type B
87632 (d) ...a hospice care waiver it shall stipulate terms and conditions of the waiver... to ensure the well-being of terminally ill residents... which shall include..., the following requirements: (2)The licensee shall notify the Department in writing within five working days of the initiation of hospice care... or within five working days of admitting a resident already receiving hospice care services... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in notifying CCLD about hospice residents, which poses a potential health and safety risk to persons in care.
87633(a)(4)Type B
87633 (a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon... to reside in the facility and receive hospice services from a hospice agency... (4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having a hospice plan for R3 and R4, which poses a potential health and safety risk for persons in care.
87705(f)(1)Type A
87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1)Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having knives and scissors accessible to residents, which poses/posed an immediate health and safety risk to persons in care.
877405(a)Type B
87405 (a) All facilities shall have a qualified and currently certified administrator...The administrator shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility... When the administrator is not in the facility, there shall be coverage by a designated substitute... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above by not having adequate attention to the management and administration of the facility , which poses a potential health and safety risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the February 13, 2024 inspection of ANGEL CARE HOME?

This was a other inspection of ANGEL CARE HOME on February 13, 2024. 14 citations were issued: 5 Type A (serious) and 9 Type B.

Were any citations issued to ANGEL CARE HOME on February 13, 2024?

Yes, 14 citations were issued (5 Type A, 9 Type B). The first citation was for: "87202(a) All facilities shall maintain a fire clearance approved by the city, county... department, or district providin..."

What type of inspection was this?

This was a other inspection. other 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.

Health check·February 13, 2024