ANGELICA'S HOME, INC.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Delgado's observation, interview and record review, the licensee did not comply with the section cited above in S1 did not have a cleared criminal background clearance, not associated to the facility, S2 was not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2026 Plan of Correction Licensee will have S1 submit fingerprints to CCLD, have S2 associated to the facility and submit proof via email to LPA by POC Due date. S1 will be placed back on the schedule when a cleared criminal background is received and is assocated to the facility.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or perimeter fence gates and that facility staff on all shifts have access to, and know how to use, equipment needed to unlock exterior doors or perimeter fence gates. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Delgado's observation, interview and record review, the licensee did not comply with the section cited above in a Master lock observed on the perimeter gate and staff is unable to locate key to unlock and there is not an approved fire clearance for locked exterior perimeter fence gate which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2026 Plan of Correction Licensee will remove the Master lock from the gate and email a picture to LPA by POC due date.

Official classification

Type A

Official code

87203

Regulation authority

HSC

What the official deficiency says

FIRE SAFETY: All facilities shall be mainained in comformity with the regulations adopted by the State Fire Marshall for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Delgado's observation, interview and record review)], the licensee did not comply with the section cited above in resident room #1 there was a white metal door guard screwed into the door frame that secures the door from opening and it is a shared room that has a bedridden and hospice living in the room which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2026 Plan of Correction Licensee will remove the metal door guard from #1 and email a picture to LPA by POC due date and ensure no devices are installed or in use for residents rooms, exit door/areas without having an approved fire clearance that states such.

Official classification

Type A

Official code

87212(A)

Regulation authority

CCR

What the official deficiency says

Emergency Diaster Plan: (A) Fire Safety Plan This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Delgado's observation, interview and record review, the licensee did not comply with the section cited above in fire extinger was observed and could not be verified to be operational as it did not have a tag to verify when it was last tested or replaced which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2026 Plan of Correction Licensee will obtain a fire extinguisher for the facility and ensure fire extinguisher is replaced annually and email a picture or receipt to LPA by POC Due date.

Official classification

Type B

Official code

87101

Regulation authority

CCR

What the official deficiency says

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Deadline recorded: Apr 17, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(B)(2)

Regulation authority

CCR

What the official deficiency says

T2287507(g)(B)(2) Admission agreements shall specify the following: Rate for additional items and services, including: A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement. Evidenced by the following: LPA reviewed documentation and interviewed Licensee to come to the deficiency.

Official plan of correction

Licensee will refund R1 to the POA $522.00, 857.00, & 1745.00 fro a total $3,124.00. Licensee will submit refund receipt to the LPA by POC date.

Deadline recorded: Apr 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

T22-81061(b)(2) Upon the occurrence, during the operation of the facility, of any events specified, a report shall be made to licensing agency within the agency's next working day during normal business hours. In addition, a written report....submitted within 7 days. Evidenced by the following... The licensee stated in interviews, and documentation review special incidents that were not reported in files.

Official plan of correction

Licensee will train all staff on reporting special/unusual incidents with documentation, sign in sheet, date and time. LPA will receive all training information and documentation by the POC date.

Deadline recorded: Apr 24, 2026. A deadline is not proof that correction was completed.