St. Therese Homes, Inc.

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year annual inspection. LPA met with Assistant Administrator (AA), Triponia "Pony" Tuazon and Designated Administrator Jermaine Aguirre. During visit, LPA toured the facility with the AA and staff to include the dining room, living room, kitchen, medication room, garage, 4 resident bedrooms, 2 staff rooms, 4 bathrooms, backyard, and exterior. All fire exit routes and ramps are free and clear of obstruction. All staff are fingerprint cleared and associated to the facility. In the backyard, LPA observed a seating area that was not shaded. Staff stated they used to have an umbrella connected to the table, however the umbrella broke. Staff immediately purchased an outdoor umbrella and showed LPA proof of purchase during visit. Facility temperature maintained at 73 degrees F. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. All items inside the refrigerator/freezer are covered and labeled. Refrigerator temperature maintained at 36 degrees F. Freezer temperature maintained at -2 degrees F. Carbon monoxide detector present and observed operable. Fire extinguisher last serviced of 06/03/2025. Medications and sharp objects observed locked in the pantry with the non-perishable foods. Snacks and fruits observed accessible in the kitchen for the residents. Chemicals, disinfectants, and toxins observed locked and stored separately from the food supply. First aid kit observed. See LIC809-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 Resident bedrooms equipped with proper furniture to include beds, linens, dressers, night stands, and adequate lighting. LPA observed 2 resident beds equipped with half rails in which the 2 resident's has a physician's order for use. Bathroom hot water temperature in bedroom #2 observed at 95.5 - 96.9 degrees F. The bathroom hot water temperature in the hallway observed at 109.9 degrees F. LPA observed a water temperature log which staff are monitoring the hot water temperature daily in the kitchen, hallway, and master bedroom. Staff measured the hot water temperature this morning which measured at 110 degrees F. LPA advised to ensure the hot water temperature in bedroom #2 is maintained within Title 22 regulations. Advisory note provided for bedroom #2's hot water temperature. LPA reviewed 3 resident files were complete and up-to-date. 3 residents centrally stored medications and centrally stored medication records were reviewed and all medications were accounted for. 3 resident's P&I money was reviewed. LPA reviewed 4 staff files were complete to include an active first aid certification, fingerprint clearance, health screening and TB result. Staff are provided annual training on topics relating to dementia care, postural supports, hospice care, restricted health conditions, incident reporting, abuse, personal rights, and medications. Facility has an updated emergency disaster plan. Emergency drills are completed quarterly and the last drill was completed on 08/01/2025. Emergency supplies observed to include flashlights, batteries, and portable power station. Facility has an infection control plan. PPE items to include gloves, hand sanitizer, face masks observed next to the isolation room. The following documents were obtained to update the facility file: Administrator certificates, LIC308, LIC400, surety bond, LIC610E, and LIC500. No deficiencies were cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Assistant Administrator (AA), Triponia "Pony" Tuazon and Designated Administrator Jermaine Aguirreand a copy of the report was provided.

On 8/9/2024 at 9:00 a.m. Licensing Program Analysts (LPAs) Maria Partoza, Marcella Tarin and Marcela Yanez arrived unannounced to conduct an annual required inspection. LPAs were greeted by two staff, and met with Triponia Tuazon, Assistant Administrator. LPAs stated the purpose of the visit. This facility is a Residential Care Facility for the Elderly (RCFE) serving adult 60 and over. 4 may be non-ambulatory, two may be bedridden in bedroom #1 and 2 hospice waiver. LPAs observed 3 of 6 residents in the activity, 3 of 6 were in their bedroom. 5 of 6 are non-ambulatory. 6 of 6 residents are developmentally disabled. At 9:10 a.m. LPAs with Staff 1, toured the facility inside and outside including the bedrooms, bathrooms, kitchen, and living room. Bedrooms and bathrooms were observed organized and sanitary. Bedrooms have sufficient storage for residents personal belongings. Bathrooms are equipped grab bars and nonskid floor mats. Facility hallways have night lights that are in good working condition. LPAs observed fire extinguishers inspected on 6/5/2024. Hot water temperature is maintained at 115-118 degrees F. The facility had their inspection by the fire Marshall on 7/31/2024. Facility temperature is maintained at 72 degrees Fahrenheit. The facility is equipped with carbon monoxide and smoke alarm system that are in good working condition. LPAs observed the kitchen to be organized and sanitary, no knives and no sharps are accessible to residents. LPAs observe a locked cabinet for the toxic and are not accessible to residents. LPAs observed the medication cabinet to be locked and secured and not accessible to residents. LPA observed 2 days of perishables and 7 days of nonperishable for the number of clients and staff. LPAs reviewed 4 of 6 resident record, including Centrally stored medications 3 of 3 staff record and observed records to be updated and complete. ~~~~~ page 1 of 2 see LIC 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 LPAs discussed an provided technical advisory to assistant administrator pertaining to 1 of 4 resident record update. LPAs reviewed 4 of 6 residents records and 3 of 3 staff records and facility record. LPAs observed residents, staff and facility record to be updated and complete. Fire & Earthquake drill training is updated and done every quarter. LPAs observe the first aid kit is complete and can be easily accessed by staff. No deficiencies were cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Assistant Administrator Triponia Tuazon. A copy of the report was provided. End of Report Page 2 of 2

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Administrator, Sandy Zipagan. During visit, LPA toured the facility to include the dining rooms, living room, kitchen, medication room, bedrooms, bathrooms, garage, and backyard. All fire exit routes are free and clear of obstruction. All staff observed to be wearing a face covering. Medications and sharp objects observed secured. LPA observed 2 days worth of perishables and 7 days worth of non-perishable foods. Facility temperature maintained at 73 degrees Fahrenheit. Hot water temperature maintained at 106.1 degrees Fahrenheit. Facility has a designated symptom screening and temperature check for all visitors and staff. Hand sanitizer made available at entry and throughout the facility. Bathrooms supplied with hygiene products, paper supplies, and hand washing sign. Facility staff clean and disinfect multiple times daily and as needed. LPA observed facility's Personal Protective Equipment (PPE) supplies. Isolation room supplied with PPE cart, donning and doffing sign, and trash bin with lid. Licensee is working on providing N95 fit-testing for staff. LPA reviewed the facility's procedures to training, testing, isolation, and monitoring. Signs observed to include social distancing, symptoms of COVID, and visitation guidelines. The following documents obtained during visit to include the LIC308 and Administrator Certificate. No deficiencies were cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Administrator, Sandy Zipagan and a copy of the report was provided.