Cobble Stone Residential Home Care

Type of visit: Required - 1 Year

On 04/09/2026 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Care Giver, Zenaida Ganas explained reason for visit and was permitted entry into the facility. Administrator, Catherine Clark was contacted and arrived a short time later. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 5 of 6 resident was present during visit. 4 of 6 residents currently receiving hospice services. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors operate on a system and last serviced on 08/27/2024. Resident rooms observed to have the required furnishings and with adequate lighting. LPA observed sufficient seating under covered patio areas. The following issues were observed during today’s visit: chemicals observed under the bathroom #2 sink, on the night stand in bedroom #2, in laundry room cabinet and in garage cabinet unlocked and accessible to residents in care. 2 of 2 resident files reviewed did not have the required documentation, 2 of 2 staff files did not have the required documentation. Disaster preparedness did not have a meeting location on facility sketch, 1 location outside the surrounding area and disaster drills are not being completed. Deficiencies cited per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care. LPA requested the following documents to be submitted to CCL by 04/17/2026: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview was conducted with Administrator, Catherine. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Required - 1 Year

On 04/03/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA introduce self, stated the purpose of the visit, and was greeted by staff Eleanor White. Administrator(A1) Catherine Clark was called and arrived shortly. All five residents were present during the inspection. LPA toured facility with A1. Administrator left the facility later during inspection. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Expired food was observed in refrigerator. At approximately 11:03AM, knives were observed stored in kitchen drawer unlock. Medications were observed locked under kitchen cabinet. MARs were reviewed and medications were checked. Chemicals were observed locked under kitchen sink. Bathrooms were toured. Cleaning supplies were observed unlocked in under hall bathroom sink and under master bathroom sink. Hot water tested at 107.8 degrees F in hall bathroom, 111.7 and 112.4 degrees F in master bathroom. Non-skid mat was observed in hall bathroom. Master bathroom was observed with no non-skid mat. Grabbed bars were observed in all bathrooms. All bedrooms were observed to have the required furnishings and with adequate lightening. Extra linens were observed. Fire extinguisher was observed with a purchased date of: 07/22/24. Chemical cabinet was observed unlock in laundry room and in the garage. Outside of facility toured and observed to be free of debris. Adequate outdoor seatings available for residents. Sample of staff and all of the residents’ files were reviewed. Carbon monoxide and smoke detector operational during visit. A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The requested documents are to be submitted to the department by 04/09/25: Lic 308, Lic 500, Lic 610E, current liability insurance, and current Administrator Certificate. A copy of this report and appeal rights was provided to Administrator via email.the state’s words, verbatim · CDSS document, Apr 3, 2025

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA disclosed the purpose of the visit and was granted entry into the facility by Staff Maribel Albandie. Administrator Catherine Clark responded to the facility to conduct the visit. A tour of the facility was conducted with the Administrator. The residence was set at 75 F temperature and free of passageway obstructions inside and outside. LPA Doucette observed 4 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 105 F. Computer room was being used as a staff bedroom and does not show on facility sketch as a fire cleared bedroom. Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked cabinet in the dining room area. Cleaning supplies were unlocked in a cabinet in the laundry room. Smoke detectors and carbon monoxide detectors were checked and operating. Facility has a pull station fire alarm. Fire extinguishers were charged and had service dates of 10/21/23. There was outdoor seating for the residents.Outdoor shed was unlocked containing pesticides. Resident, medication and staff records were reviewed. Medication error was found for R1. Resident prescription was crossed out where it shows the description of how the prescription should be administered. Facility staff wrote two different start dates on the prescription. LPA took photos. R1 did not have a Hospice Care Plan. Mars log did not have a current log for R1 pertaining to the medication with the two start dates. Current first aid and CPR were on file for staff. Staff did not have training for R1's Hospice Care. Deficiencies were observed and will be cited under Title 22, Division 6. See LIC 809D. Civil Penalty was issued. An exit interview was conducted with the Administrator. A copy of this report, plan of correction and appeal rights were discussed and left with the Administrator, Catherine Clark, and a copy of this report will be emailed.the state’s words, verbatim · CDSS document, Apr 23, 2024

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.