A Nice Care Home

Type of visit: Required - 1 Year

At approximately 11:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Cheryl Gambonini, Licensee. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care, all of whom were present during today's inspection. Facility is approved for six (6) residents, has a Dementia Care Plan, a Hospice waiver for three (3), and is approved for all non-ambulatory residents,. At approximately 11:30 AM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the front and backyards with outdoor space for activities. LPA observed another structure which was locked and is used as a bakery and the contents of which is mostly baking supplies and holiday decorations. Facility has an internet access device available for resident use. Facility has internet service available to residents in care and the telephone was tested an operational during inspection. Facility's 2 fire extinguishers were observed charged and were last serviced 12/2024. Licensee agrees to Continued on LIC809-C... Continued from LIC809C... have all facility fire extinguishers serviced immediately to remain in compliance with regulation. Smoke and Carbon Monoxide detectors were tested and 3 of 6 were non-operational during inspection. Licensee showed LPA new smoke detectors ready to be installed and called to schedule an electrician to relace them during today's inspection. Facility conducts bi-annual disaster drills, and the most recent drill was conducted 11/2025. LPA informed Licensee that drill shall be conducted on a quarterly basis moving forward, and Licensee agreed to bring the facility into compliance. LPA observed the facility's infection control plan, first aid kit, PPE, emergency supplies, and facility has a generator for emergency preparedness. LPA reviewed facility's emergency disaster plan last updated 11/2025. At approximately 1:30 PM, LPA conducted file review. Three (3) staff files and four (4) resident files were reviewed. All staff files reviewed were missing proof of all 20 hour of the required annual training and 2 of 3 were missing proof of all of the required initial 40 hours of training per regulation, (see LIC809D). Staff files reviewed have proof of current First Aid and CPR certification. Four (4) of four (4) resident files reviewed contained the required documentation. Licensee states that most of the residents' family members coordinate residents' medical and dental appointments and transportation to and from visits. However, Licensee is available to assist with this as needed. Medications and medication records were inspected and the logs were observed maintained in compliance with regulation. Facility does not handle P&I. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500 - Personnel Report (updated) Proof of Liability Insurance (Updated) LIC610E - Emergency Disaster Plan (Updated) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted with Licensee whose signature on form confirms receipt of documents. Appeal rights provided.the state’s words, verbatim · CDSS document, Dec 3, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 2:00 PM, Licensing Program Analysts (LPAs) Julie Florio and Ali Deniz arrived unannounced to conduct a required 1-year annual inspection and were greeted by staff. Cheryl Gambonini, Licensee/Administrator was contacted via telephone and arrived approximately 15 minutes later. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care, all of whom were present during today's inspection. Facility has a Dementia Care Plan, a Hospice waiver for three (3), and is approved for all non-ambulatory residents,. At approximately 2:30 PM, LPAs initiated a tour of the facility with Administrator and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. LPAs observed at least 15 instances of expired perishable and non-perishable food items, (see LIC809D). Medications were centrally stored and locked. There is a shaded seating area in the front and backyards with outdoor space for activities. LPAs observed another structure which was locked and is used as a bakery and the contents of which is mostly baking supplies and holiday decorations. Resident were observed engaged in community word games during inspection. Facility has an internet access device available for resident use. Facility has internet service available to residents in care and the telephone was tested an operational during inspection. Continued on LIC809-C... Continued from LIC809C... Facility's 2 fire extinguishers were observed charged and were last serviced 12/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts bi-annual disaster drills, and the most recent drill was conducted 01/2025. LPAs informed Licensee that drill shall be conducted on a quarerly basis moving forward, and Licensee agreed to bring the facility into compliance. LPAs observed the facility's infection control plan, first aid kit, PPE, emergency supplies, and facility has a generator for emergency preparedness. LPAs reviewed facility's emergency disaster plan last updated 1/2025. At approximately 4:00 PM, LPAs conducted file review. Three (3) staff files and four (4) resident files were reviewed. All staff files reviewed were missing at least one (1) of the required documents, (See LIC809D). All staff have proof of required current First Aid certification. Four (4) of four (4) resident files reviewed were observed missing at least one (1) of the required documents, (See LIC809D). Administrator states that most of the residents' family members coordinate residents' medical and dental appointments and transportation to and from visits. However, Administrator is available to assist with this as needed. Medications and medication records were inspeccted and the logs were observed to not be maintained in compliance with regulation, (see LIC809D). Facility does not handle P&I. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500 - Personnel Report (updated) Proof of Liability Insurance (Updated) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Appeal rights were given. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jan 17, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required – 1 yr. inspection of the facility. LPA was welcomed by Licensee – Cheryl Gambonini. There are 5 residents at facility, currently 1 on hospice 2 with diagnosis of dementia. LPA conducted tour of facility on 12/4/2023 at 9:00 AM with Licensee/Administrator and observed; facility was found to be clean and in good repair; all walkways and exits were free from obstruction. Exits were equipped with auditory devices. Fire Extinguisher was found to be last charged on 12/14/2022 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Facility has fire sprinklers throughout, last inspection conducted will be submitted. There was enough lighting in all common areas, resident rooms, and hallways. Hot water temperature measured between 111 degrees F and 114.6 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 12/4/2023. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the kitchen and locked closet in hallway. Kitchen drawer containing sharps was inaccessible to residents in care. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers, although staff informed some residents flush paper towels and clog toilets. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings per Title 22 Regulations. Continue on LIC809-C A review of five resident & four staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files at 10:00 AM and learned that 5 of 5 residents have an updated re-appraisals/needs & care plans and physician’s assessments (LIC 602A). LPA reviewed a sample of staff records at 11:45 PM and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff annual training requirements for 2023 are on file. LPA was presented with proof of 1st Aid certification for staff files reviewed; although no staff had current CPR certification (see LIC 809-D). Medication is centrally stored and secure in locked cart in dining room. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 12/4/2023 at 12:30 PM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. Cheryl Gambonini Administrator Certificate # 6007021740 expired but LPA was provided proof of training's and documents with payment sent, recertification received on 1/10/2023, still pending. Disaster Drills are conducted quarterly with the last one being conducted on 5/17/2023. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternate meeting locations. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 1/8/2023: Continued on LIC809-C LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Fire Sprinkler Inspection Copy of Control of Property/Deed Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Dec 4, 2023

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.