Routine inspection·June 4, 2025

On June 4, 2025 at 1:15 PM Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Orlando Delos Angeles. Licensee (LI) Concordia Velasco was contacted over the phone and LPA explained the purpose of the visit. LI Velasco arrived around 1:50 PM and left around 3:20PM. LI Velasco stated that CG Delos Angeles could sign in behalf of the facility. The facility is licensed to operate for four (4) non-ambulatory and have a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: Three (3) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living area, dining area, kitchen, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with LI Velasco. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Staff Room 1. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 109.7 and 109.9 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. LPA Kim observed emergency food and water are stored in the pantry next to the facility entrance. The facility has smoke detectors and carbon monoxide detectors that were operable. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). A working telephone (714-990-5952) remains available. First Aid Kit contained all the necessary elements. LPA conducted an audit of all resident files (R1-R4), all staff files (S1-S2), and medication and medication administration record. LPA Kim conducted two (2) resident interviews and one (1) staff interview. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed a bottle of Cascade and a bottle of Finish Jet dry in an unlocked cabinet under the kitchen sink. LPA observed S1 did not have a valid CPR/First Aid certificate, and the PUB475 See Something Say Something measured at 10.5” x14.5” instead of the 20" x 26" requirement. An exit interview was conducted and a copy of this report and appeal rights were provided to Caregiver Orlando DeLos Angeles.