Inspection visit

Routine inspectionAugust 7, 2024

HUMBLE HAVEN RCFE IILicense 19761000811 citations on this visit

11 citations recorded

Inspector’s narrative

What the inspector wrote

On 08/07/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced required annual visit. LPA Melissa Spaeth was greeted by a caregiver. LPA Spaeth spoke to the Licensee, Nicole De Las Alas by phone and the Licensee arrived at 10:20 am. The Licensee stated they have sold the facility to another individual but did not know the status of the buyer's application with CCL. The Licensee also stated the two staff members working at the facility were hired by the new owner. The Licensee stated they had a personal appointment and had to leave the facility. The Licensee left at 11:05 am. The facility is licensed as a Residential Care Facility for the Elderly (RCFE) to serve six residents of which six (6) may be non-ambulatory and one (1) may be bedridden. There is a hospice waiver for three residents. There are five residents living in the facility. At 11:15 am, a former staff member arrived and stated they had purchased the facility as of May, 2024 and they had been a previous staff member of the facility. LPA Spaeth observed the previous staff member and the two caregivers who are currently working at the facility had received criminal record clearance. LPA and the caregiver began the tour at 10:00 am until 11:00 am. LPA Spaeth observed the following: Common areas – LPA observed the family room contained comfortable seating. Dining Room/Kitchen Combination – LPA observed a seven-day supply of non-perishable food and a two-day supply of perishable food in the refrigerator. LPA Spaeth observed the kitchen knives and cleaning solutions were locked underneath the kitchen sink. The medications were safely locked in a kitchen cabinet. Backyard - LPA observed comfortable seating located in a shaded area. The gate leading from the backyard to the front yard was not locked. Continued on 809-C. Resident Bedrooms – LPA observed the five residents’ rooms were neat and clean. The bedrooms contained a bed, linens, night stand, night lamp, chest of drawers and closet. Bathrooms – The two bathrooms contained hand soap, paper towels, trash can, a slip resistant mat, and grab bars. LPA Spaeth tested the water temperature at 10:50 am in the resident’s bathroom and the water temperature was 126.6 degrees F. Hallway Closet – The closet contained clean linen and PPE supplies. Staff Room – The staff’s bedroom was locked. Garage – The garage was locked and contained the washer, dryer, laundry detergent and an additional deep freeze filled with frozen meats and vegetables. Smoke/Carbon Monoxide Detector - The detectors were tested at 11:00 am and were functional. LPA reviewed the residents’ files at 1:00 pm until 1:30 pm. LPA reviewed the staff files at 2:00 pm until 2:30 pm and observed there were no staff files for the two caregivers working at the facility. Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted, Appeal Rights discussed, and a copy of the signed report was given to the caregiver.

Citations

11 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.

87412(c)(2)(D)2Type B
Based on LPA's observation the licensee did not comply with the section cited above. The two caregivers have not completed the required job training which poses a potential health, safety or personal rights risk to persons in care.
87412(c)(2)(D)3Type B
Based on LPA's observation the licensee did not comply with the section cited above. The two caregivers have not completed the required job training which poses a potential health, safety or personal rights risk to persons in care.
1569.618(c)(3)Type A
Based upon LPA's observation, the licensee did not comply with the section cited above. The two caregivers working at the facility verbally confirmed they had not completed CPR and first aid training which poses an immediate health, safety or personal rights risk to persons in care.
1569.626(a)(2)Type B
Based on LPA's observation, the licensee did not comply with the section cited above. The two caregivers have not completed the above-referenced training which poses a potential health, safety or personal rights risk to persons in care.
1569.69(a)(4)(D)Type B
Based on LPA's observation, the licensee did not comply with the section cited above. The two caregivers have not completed the above-referenced training which poses a potential health, safety or personal rights risk to persons in care.
1569.69(a)(4)(E)Type B
Based on LPA's observation, the licensee did not comply with the section cited above. The two caregivers have not completed the above-referenced training which poses a potential health, safety or personal rights risk to persons in care.
1569.69(a)(4)(F)Type B
Based on LPA's observation, the licensee did not comply with the section cited above. The two caregivers have not completed the above-referenced training which poses a potential health, safety or personal rights risk to persons in care.
87303(e)(2)Type A
Based on LPA's observation during the tour of the facility, the licensee did not comply with the section cited above. The water temperature was tested in the resident's bathroom and was 126.6 degrees F which poses an immediate health, safety or personal rights risk to persons in care.
87411(c)(1)Type A
Based on the LPA's observations, the licensee did not comply with the section cited above. The two caregiers have not completed the CPR and first aid training which poses an immediate health, safety or personal rights risk to persons in care.
87411(f)Type A
Based on the LPA's observation the licensee did not comply with the section cited above. The two caregivers have not completed the health screening including the chest x-ray or an intradermal test which poses an immediate health, safety or personal rights risk to persons in care.
1569.69(a)(4)(G)Type B
Based on LPA's observation, the licensee did not comply with the section cited above. The two caregivers have not completed the above-referenced training which poses 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 August 7, 2024 inspection of HUMBLE HAVEN RCFE II?

This was a inspection inspection of HUMBLE HAVEN RCFE II on August 7, 2024. 11 citations were issued: 4 Type A (serious) and 7 Type B.

Were any citations issued to HUMBLE HAVEN RCFE II on August 7, 2024?

Yes, 11 citations were issued (4 Type A, 7 Type B). The first citation was for: "Based on LPA's observation the licensee did not comply with the section cited above. The two caregivers have not complet..."

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·August 7, 2024