St. Lourdes Home

On this day, August 13, 2025, at 12:40 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Warlita Romero and Norma Gano. LPA called and spoke over the phone with Justino Balintona, licensee-administrator, and informed the reason for visit. LPA asked, and licensee-administrator authorized Norma Gano to be with LPA during inspection. Licensee-administrator arrived around 1:15 pm. LPA started inspection with Norma Gano and continued with licensee-administrator. LPA inspected the dining room, kitchen, bedrooms, bathrooms, living room, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was locked. Facility has smoke and carbon monoxide detectors that were tested and observed in operating condition. Hot water temperature in the common bathroom was tested, and measured at 111.6 degrees Fahrenheit. Facility conducts drills and record showed last conducted July 12, 2025. Fire extinguisher checked and receipt showed purchased May 20, 2025. LPA reviewed 5 residents and 5 staff files, and interviewed 4 residents. Medications checked, and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. ...continued on 809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA observed the following: -at 12:55 pm, medications in kitchen drawer without lock. -at 1:10 pm, Ca-Rezz incontinent wash, Hydrocortisone cream, lighter in unlocked closet in the hallway. -at 1:15 pm, Ca-Rezz in the common bathroom. -at 1:20 pm, unlocked scissors in the resident's room. -at 1:22 pm, Hydrocortisone cream, Ca-Rezz incontinent wash and shaving cream in another resident's room. -at 1:31 pm, scissors, mallet, hammer, screw drivers, lubricant in a plastic storage container in the backyard. -at 3:00 pm, staff (S2) does not have postural support training for 2024. -at 3:15 pm, staff (S3) who was hired in 2024 has only 16 hours of the total 40 hours required training. -at 3:20 pm, staff (S4) does not have postural support training for 2024. -at 3:32 pm, staff (S5) has not completed the required 40 hours of training within the required first 2 weeks of employment. -at 4:15 pm, resident (R2) has multi Vitamins and Ferrous sulfate administered but these are not included on the medications/supplements listed on LIC602A dated 5/27/25. -at 4:50 pm, resident (R3) has 1 medication on listed in After Visit Summary dated 8/05/25 but facility does not have the medication. -at 5:35 pm, resident's (R4) two prescribed medications filled on 6/18/25 and one filled on 7/18/25 not listed on LIC622 Centrally Stored Medication and Destruction Record. Facility does not have 3 of the prescribed medications. Tylenol (Acetaminophen) order is 325 mg but the one in facility's hand is 500 mg. LPA obtained copies of the following updated/current documents: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. $3M liability insurance certificate .......continued on 809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $250.00 civil penalty is assessed for repeat violation of section 87309(a) within 12 month period and will continue for $100.00/day if not corrected. Failure to submit proof of corrections for the other deficiencies may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the licensee-administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, LIC421FC Civil Penalty Assessments, and copy of this report provided.

On this day, August 7, 2024, at 10:30 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Warlita Romero and Margarita Corazon Mariano. LPA called and spoke over the phone with Justino Balintona, licensee-administrator, and informed the reason for visit. LPA asked, and licensee authorized Warlita Romero to be with LPA during inspection. Licensee-administrator arrived after about 25 minutes. Facility has Infection Control Plan that was submitted on 8/19/22. LPA started inspection with Margarita Corazon Mariano and continued with administrator. LPA inspected the dining room, kitchen, bedrooms, bathrooms, living room, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was locked. Facility has smoke and carbon monoxide detectors that were tested, and observed functional. Hot water temperature in the common bathroom was tested, and measured at 108 degrees Fahrenheit. Facility conducts drills and record showed last conducted 7/08/24. LPA reviewed 4 staff and 5 residents files, and interviewed 2 staff. Facility does not handle residents' cash resources. Medications checked, and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. LPA observed the following: -at 10:42 am, refrigerator's vegetable crispers with mold, rotten bitter melon leaves, rotten asparagus and lettuce. ...continued on 809C (page 2) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 2 -at 10:52 am, Voltaren, athlete's foot and hydrocortisone ointments in the drawer in one of the resident's room, and CaRezz continent and Chloehexine gluconate rinse in the closet in this resident's room. -at 11:07 am and 11:09 am, broken drawer knobs in 2 resident rooms and missing drawer knob in the drawer by the hallway. -at 11:10 am, razors in the common bathroom. -at 11:12 am, bathroom cabinets with heavily peeled varnish and soiled bath tub. -at 11:17 am, ensuite bathroom's shower door with mildew. -at 11:20 am, Raid insect killer, gallons of liquid sanitizer, expired canned foods and rotten cauliflower in unlocked storage in the backyard. - at 11:24 am, automotive agents, bug and windshield cleaner, stain remover, rusted metal cart in the backyard. -at 11:38 am, staff's medications in the living room. -at 1:49 pm, resident's (R2) LIC602A Physician's Report revealed R2 is bedridden and dependent on others with all activities of daily living (ADLs). LPA observed R2 unable to reposition on his own. -at 2:50 pm, resident (R1) has doctor's order for Mupirocin (3x/day), Asprin 81 mg (1 tab/day), Colchicine, but facility does not have these meds. Acetaminophen 315 mg (PRN) but at facility's hand is 500 mg. HydrAlazine order is 50 mg 3x/day but at facilty's hand is 25 mg 3x/day. Quetiapine 25 mg 1 tablet daily but label on this medication is 2x/day. Vitamin D3's order is 25 mcg (1,000 IU) but on hand is 50 mcg (2,000 IU) and facility administers 50 mcg daily. Voltaren, multi Vitamins & stool softener have no order on file. -at 3:35 pm, resident (R4) has order for 2.5 mg Lisinopril but facility does not have this medication. -at 4:00 pm, resident (R5) has discontinued order for Lisinopril 20 mg but facility is administering this medication. Has order for Albuterol 2.5 mg but facility does not have this medication. Has Quetiapine 25 mg but no doctor's order on file. ....continued on 809C (page 3) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 3 LPA received the following updated/current documents on this day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section 87202(a)(2). Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the licensee-administrator. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.

On this day, August 2, 2023, at 12:00 p.m,, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Warlita Romero and Margarita Corazon Mariano. LPA called and spoke over the phone with Justino Balintona, licensee-administrator, and informed the reason for visit. LPA asked, and licensee authorized Warlita Romero to be with LPA during inspection. Licensee arrived after about 20 minutes. Facility has Infection Control Plan that was submitted on 8/19/22. LPA toured the facility inside out. LPA inspected the dining room, living room, kitchen, bedrooms, bathrooms, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was locked. Facility has smoke and carbon monoxide detectors that were tested, and observed functional. Hot water temperature in one of the bathrooms was tested, and measured at 106.7 degrees Fahrenheit. Facility conducts drills and record showed last conducted 4/22/23. LPA reviewed 4 staff and 5 residents files, and interviewed 2 staff and 2 residents. Facility does not handle residents' cash resources. Medications checked, and compared with records and doctor's orders. LPA observed the following: -at 12:14 pm, All Purpose cleaning agents, Lysol and Purell surface cleaner, Comet in ensuite bathroom cabinet without proper lock. ...continued on 809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 -at 12:17 pm, transition metal plate and wood plank in the transition area between the room and ensuite bathroom detached from the flooring. -at 12:24 pm, Lysol and Glade sprays in the common bathroom. -at 12:27 pm, wound, peritoneal cleansers. skin protectant ointment, Glade spray and Natural Breeze spray in one of the resident bedrooms. -at 2:25 to 2:30 pm, staff (S2, S3 and S4) h as only 2 hours dementia training & no 4 hours postural support/restricted health/hospice training for 2022. -at 4:20 pm, R5 has Melatonin OTC medication but not listed on most current list of doctor's order of medications. LPA received the following updated/current documents on this day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the licensee. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct annual/infection control annual inspection. LPA met with staff, Corazon Mariano and Warlita Romero. LPA called and spoke over the phone with Justino Balintona, licensee-administrator, and informed the purpose of visit. Justino arrived after several minutes. Facility has LIC808 Mitigation Plan on file. LPA started inspection with Warlita, and continued with Justino. LPA inspected the living room, dining area, kitchen, bed rooms, bathroom, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. LPA observed screening station located near the front entrance with visitor's log, hand sanitizer and no touch thermometer. Surgical masks and disposable gloves are readily available at the screening station. Visitor's temperature and symptom checks are done at the entrance. Staff are screened for COVID-19 symptoms and temperature is checked and recorded daily. Antigen test kits are readily available. COVID-19 signages were observed posted all throughout the facility. All trash bins were observed with touch free/foot pedal operated lids Supplies of PPEs were checked. All staff were fit tested for N95 respirators on July 23, 2021 . LPA discussed the requirement for yearly N95 fit testing Licensee stated he'll re-fit test the staff. ......continued next page 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Hot water temperature at the common bathroom was tested and measured at 114,7 degrees Fahrenheit. Fire extinguishers checked, observed fully charge and receipt showed purchased May 31, 2022. Smoke and carbon monoxide detectors were tested and observed operational. . At 12:50 pm, LPA observed bleach, Great Value All Purpose Cleaner with Bleach, Comet and ant & roach killer in unlocked kitchen cabinet. Licensee to submit the following updated documents by August 22, 2022: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Updated N95 fit testing record 5. Infection Control Plan Deficiency is cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.