Casa Pastel Care Home.

On 12/16/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Jeon Tulagan, Caregiver and explained the purpose of the visit. Lei "Becky" Bi, House Manager arrived later during the visit. LPA toured the physical plant. This is a 1-story building with 9 bedrooms(6 bedrooms for residents and 3 for staff), 7 bathrooms(5 for residents and 2 for staff), a back and front yard, living room, dining room, kitchen, garage, and office. All bedrooms had the required furniture and sufficient lighting. The facility's bathrooms had anti-slip flooring and grab bars. No accessible bodies of water or hazards were observed. The facility's fire alarms and carbon monoxide detectors were observed to be in working order. The facility's fire extinguisher was observed to be fully charged and last checked on 01/21/2025. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility's first aid kit had the required items. LPA reviewed 5 resident files and 6 staff files. All were observed to be complete. During the visit, LPA obtained copies of the following documents: Current Liability Insurance. LPA requested Current LIC 500 and Administrator certificate be sent to the Department by 12/23/2025. During file review, LPA observed no staff training records for 2025. A Type B citation was provided for this deficiency. During file review, LPA also did not see notes regarding date and time of each contact with the physician, and the physician's directions, which shall be documented and maintained in the resident's facility record. 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 A review of Centrally Stored Medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. Deficiencies are cited under the California Code of Regulations. Failure to correct the deficiencies by the POC due date may result in Civil Penalties. An exit interview was conducted. A copy of this report along with Appeal Rights was provided.

On November 26, 2024, at 8:50 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the staff members S1 and S2 and disclosed the purpose of the inspection. Administrator, Becky Bi arrived shortly after. The administrator informed the LPA that the facility currently has 6 residents in care, with 4 of them are non-ambulatory and 2 residents are on hospice. At 9:20 AM, the LPA initiated a walk-through of the facility, accompanied by the administrator. At 9:22 AM, the LPA inspected the kitchen and found it clean, with no food preparation or cooking in progress at the time. A bottle of dish washing soap was observed placed on the sink. The LPA checked the appliances and observed them in working order. The LPA inspected the refrigerator and pantry cabinets and observed enough supplies of fresh perishable food for (2) days and nonperishable staples for (7) days. No expired food and no stored medications were noticed. At 9:30 AM, the LPA observed knifes and scissor kept in an unlocked kitchen cabinet and accessible to residents in care. LPA observed Comet bleach and Clorox disinfectant wipes in a closet underneath the kitchen sink and accessible to residents in care. At 9:38 AM, LPA inspected the dining area and observed it clean, with all the furniture in good repair. There was a dining table and enough chairs to accommodate all the residents. The LPA inspected the fire extinguisher mounted on the wall and found it was fully charged with last a service tag of 02/06/2024. The administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit. Continued on LIC 809-C 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 9:42 AM, the LPA observed R6 wearing a Transfer belt and S2 used this belt to help R6 get up from the sofa. LPA reviewed R6’s records and didn’t see Physician’s report in the file indicating the need for the postural support. There are (6) bedrooms and (5) bathrooms designated for residents' use, (2) bedrooms and (1 1/2) bathrooms designated for staff, and (1) office room. All resident rooms are single occupancy. Resident bedrooms #1, #2, #4 and #5 have private bathrooms. At 9:48 AM, LPA inspected all (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. At 10:04 AM, LPA inspected the common resident bathroom and found it clean, sanitary, and in good working condition. It contained soap, grab bars, a trash can, non-slip flooring, and a shower chair. The hot water temperature at the sink faucet was measured at 112.1°F. At 10:12 AM, the LPA inspected the hallway half bathroom and observed it in clean, sanitary, and operating condition. The hot water temperature at the sink faucet was measured at 110.6°F. At 10:16 AM, the LPA inspected the storage space in the hallway and observed it containing clean linens for residents’ use and found it well organized. At 10:20 AM, LPA inspected the garage and observed a washer, dryer, refrigerator, and freezer. The garage was observed cluttered with boxes, Incontinence supplies, furniture, food supplies, and mattresses. At 10:26 AM, LPA toured the backyard area. The backyard has a set of patio table, chairs, and umbrella for resident use. There were no bodies of water noted and was found clear of obstructions. At 10:38 AM, the LPA inspected the office, staff bedrooms, and staff bathroom and found them clean. At 10:53 AM, The LPA reviewed (4) staff personnel records and (6) resident records. The LPA reviewed that 2 of 6 residents records didn’t contain Physician's Reports. LPA reviewed that 2 of 4 staff members didn’t have LIC 503 Health Screening. LPA reviewed that 1 of 4 staff members is not associated with the facility. At 11:07 AM, the LPA observed a locked centrally stored medication cabinet located inside the staff/administrator room. Medications were organized in separate bins for each resident. All medication bottles were properly labeled. Centrally Stored Medication Record (CSMR) were reviewed and found to be complete. Continued on LIC 809-C 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 11:16 AM, the LPA inspected the first aid kit and observed it fully stocked. At 11:20 AM, the LPA reviewed Emergency Drill Logs and observed Emergency Disaster Drills were not conducted quarterly, with the most recent drill completed on 1/07/2024. The following updated forms are requested to be submitted to CCLD by 12/03/2024: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with the Administrator, Becky Bi, whose signature on this form confirms receipt of these documents.