198601619-3-11-2025-28-AS-KRAZ-DENSYB-20250311141715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601619
Report Date: 03/11/2025
Date Signed: 03/11/2025 02:17:34 PM

Document Has Been Signed on 03/11/2025 02:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	ST. DANIEL'S ELDERCARE, INC		FACILITY NUMBER:	198601619
ADMINISTRATOR/ DIRECTOR:	DEBORAH DAVIS		FACILITY TYPE:	740
ADDRESS:	1760 BRIDGEPORT AVE		TELEPHONE:	(909) 624-1093
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	03/11/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:04 AM
MET WITH:	Administrator		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 3/11/2025 and was greeted by Administrator Deborah Davis. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected six (6) resident rooms. LPA Ramirez inspected six (6) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Bedroom#2 is currently unoccupied. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside showers. LPA Ramirez observed no-slip mat in showers. Showers were observed to be wheelchair accessible.

Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents.

Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C).

During facility tour, it was revealed resident#1 (R1) was released from skilled nursing on 3/5/2025 with home health wound care. Staff interviews and interview with R1’s responsible party revealed R1 currently has a stage 4 wound on their coccyx. R1 is not on hospice at this time. Per Title 22, Division 6, Chapter 8, Article 11. Health Related Services and Conditions- Prohibited Health Conditions- 87616(a)(1)- Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. LPA Ramirez will issue a type A deficiency based this observation, and interviews conducted. Administrator agreed to draft a plan what steps the facility will take to address R1’s prohibited health condition.

Due to time restraints, LPA Ramirez will return at a later time to complete annual inspection. One (1) violation was cited. A copy of this report, 809-D and appeals rights was provided via email.

Tony Vasallo	TELEPHONE: (323) 981-3977
Kimberly Ramirez	TELEPHONE: (323) 981-3970
	DATE: 03/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/11/2025 02:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ST. DANIEL'S ELDERCARE, INC	FACILITY NUMBER: 198601619
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87616(a)(1)

Prohibited Health Conditions- 87616(a)(1)- Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: R1 was admitted back into the facility with a prohibited health condition.
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in 1 out of 6 residents which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/12/2025
	Plan of Correction
1 2 3 4	Administrator agreed to draft a plan by 3/12/25, that indicates what steps the facility will take to address R1’s prohibited health condition. Administrator will retrain staff on this regulation and send proof of retraining by 3/18/2025.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Tony Vasallo	TELEPHONE: (323) 981-3977
Kimberly Ramirez	TELEPHONE: (323) 981-3970
	DATE: 03/11/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC809 (FAS) - (06/04)

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