Routine inspection·September 19, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by administrator Robert Aquino. There is a licensing application in progress for the same address under facility Queen of Angels Care Home - 306006821, which was submitted to the Centralized Application Bureau on July 17, 2025. There are currently six residents in care, one of which is receiving hospice care at this time. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas. Three resident interviews conducted during the visit. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with four private bedrooms and two shared rooms. There are two shared bathrooms used by residents, one of which is en-suite from the shared bedroom. Bedrooms appear clean and sanitary. One resident uses full-length rails for postural support, with one order from hospice reviewed during the visit. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 110F in one of the bathrooms used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. There are three wall-mounted fire extinguishers present, all verified to be charged with up-to-date maintenance tags. Carbon monoxide and smoke detectors were found to be present and operational. Emergency water supplies are observed to be stored in the locked laundry room. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with outdoor furniture for resident use. The identified route of egress is free of clutter and obstructions. There is one self-latching gate on one side of the premises. There are no bodies of water present. The facility does not utilize locked perimeters or delayed egress. LPA reviewed six resident records which included all necessary components. Multiple admission agreements were observed to be missing the administrator's signature. Type B deficiency cited. One bedridden resident found to be present during the annual visit conducted on September 13, 2024 is still admitted to the facility. Fire clearance has not been updated for the present facility, however the Fire Marshall conducted a visit on September 18, 2025 for the purpose of the upcoming licensing application and granted a bedridden fire clearance after a fire door was added onto the shared room. Type A deficiency cited for the present license however. LPA reviewed resident medication records and prescription orders with no discrepancies observed. LPA reviewed staff records for two staff members during the visit. Proof of current CPR training reviewed. Initial and annual training is documented. Disaster drills are conducted quarterly and documented. All staff members including relieving staff are verified to be background cleared and associated to the licensed location. The administrator certificates are current. Based on the observation conducted during the present visit, one type A and one type B deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.