The Cottage

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced annual visit today. LPA met with Stacy Santana Lopez, Manager, and the visit for the visit was explained. Linda Morales, Administrator, arrived thereafter. The facility is licensed to serve (6) bedridden; Hospice waiver approved for (6). Facility is operating within the scope of its license. The facility is in a residential area of Pasadena and it consists of living room, dining area, kitchen, (3) resident bedrooms, (2) full bathrooms, attached garage, laundry/supply room and front and back yard. During today's visit, the following was observed: Facility is clean and walkways, ramps and staircases are free of debris and obstructions. Furniture throughout the facility is in good repair. There is sufficient seating in the living and dining room for residents. Bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Extra linen is kept in hallway closet. Physician orders are in place for bed rails. Kitchen appliances are clean and were operating at the time of visit. Sharps and cleaning supplies are kept locked inaccessible to residents. Sufficient supply of 2 day perishable and 7 day non-perishable food was observed. Bathrooms were inspected and were observed clean and sanitary. Bathrooms have safety grab bars and anti slip mats. Bathing assistive devices were also observed in good repair. Water temperature was tested in both bathrooms and measured within the required 105 - 120 degrees F. Sufficient cleaning supplies for are kept in the laundry room. ***Continues on LIC 809-C*** The front and backyard are clean and there are no pools or large bodies of water. Shaded areas and seating was observed in the front and backyard. Patio furniture was observed clean and in good repair. Gardens are maintained and outdoor passageways are kept free of debris and obstructions. Washers and dryers are operable and laundry room is free of clutter. Garage is used to store incontinence and personal hygiene supplies. Smoke and carbon monoxide detectors were tested and are working properly. Fire extinguisher in the home is kept charged and was last serviced on 6/30/2026. Drills are conducted monthly. Last fire/safety drill was conducted on 7/5/2026. Four resident and four staff files were reviewed and contained required documentation. Medication is kept centrally stored, locked and inaccessible to residents. Medication was observed to be administered and documented according to physician's orders. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies noted during today's visit. Exit interview conducted with Stacy Santana Lopez and Linda Morales, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jessica Lopez caregiver and explained the reason for the visit. The facility is licensed to serve (6) bedridden residents ages 60 and over. The facility is located in a residential area behind another home, and consist of a dining room, living room, kitchen, (3) resident bedrooms, (2) resident bathrooms, a back yard, a garage, and a shared front yard and laundry area. The following domains were reviewed during this visit: Infection Control: Facility does not have a copy of infection control. All staff have a TB clearance. Operational Requirements: Facility maintains a plan of operation, fire clearance. Facility is operating within the limitations of their license. They currently don't one resident under hospice care. A current liability insurance was observed and a copy was obtained. Physical Plant/Environmental Safety: LPA toured the facility with Jessica Lopez caregiver and observed the following. Facility was observed in good repair. Living room and dining room were observed with furniture and in good repair. Kitchen was observed clean. Cleaning supplies and sharps are maintained in a locked cabinet. Refrigerator/freezer and pantry were observed. Medication cabinet is located in hallway. Three (3) resident rooms were observed with sufficient lighting, required furniture and bedding supplies. Exit doors in each bedroom exiting the facility have a sound device that were observed not working at the time of the visit. Bed rails were observed in each residents' bed. Resident #1 and #3 have 3/4 bed rails and there is no physician's request on file. Two (2) bathrooms were observed in good repair and clean. Water temperature was tested in each bathroom sink and tested between 66.7 - 103.4 degrees F., which is not within the required 105-120 degrees F. (CONTINUED ON LIC809C) There are no large bodies of water at the facility. Carbon Monoxide/Smoke detectors were tested and are in working condition. Passage ways were observed clear of obstructions. Backyard and front yard were observed with shaded seating area. Staffing: Administrator certificate was reviewed for Chris Gutierrez was not available. LPA checked on the department's website and did not find a request for renewal. Linda Morales has an administrator certificate which is pending for renewal and is the responsible person. CPR/First aid training was observed for staff. Staff is on duty during the night shift. Personnel Records/Staff Training: LPA reviewed 5 staff files. Files were available for review. Files include; TB clearance, health screening, background clearance, personnel record, and training for each staff. Staff #4 does not have a health screening on file. Staff #5 is not associated to the facility and has been working since 10/20/25. Three staff were interviewed. Resident Rights/Information: License, Let us Know (PUB 475), Ombudsman, personal rights posters were posted throughout the home. Planned Activities: Facility provides activities such as puzzles, books and interactive dolls. Food Services: LPA observed at least 2 days of perishables and 7 days of non- perishable food supplies. An additional refrigerator was observed in the laundry area. Kitchen was observed clean and free of pest. Staff were observed practicing hygiene and infection prevention. Two out of three residents have a modified diet per medical assessments. Incidental Medical and Dental: Facility provides assistance with medical/dental arrangements and with medication assistance. Medications were observed stored in locked medication cabinet. LPA reviewed medication for 3 residents. Resident Records/Incident Reports: LPA reviewed 3 residents files, each contained admission agreement, medical assessment, TB clearance, pre-appraisal, and appraisal. One resident was interviewed. Disaster Preparedness: LPA reviewed emergency disaster plan LIC 610E(3/19) last reviewed on 5/25/24. Emergency drills are conducted monthly, last emergency drill was conducted on 7/14/25. Residents with Special Health Needs: Facility is serving 1 resident on hospice, resident #1. No bedridden. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Stacy Lopez Manager and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 19, 2025

The state marks this report as 9 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) Sanjay Vaid conducted an unannounced Annual Required Visit on 05/23/24 at 9:05 am. LPA was met by Staff #1 (S1) and explained the purpose of the visit. Facility is licensed to serve residents over 60 years old. The facility cares for elderly residents with dementia and is allowed to care for six (6) bedridden residents. LPA Vaid requested and obtained copies of Personnel Report (LIC 500), Resident Roster (LIC 9020). Staff #2(S2) arrived shortly after. LPA OBSERVATIONS: Tour began at 9:18 am and was led by S2. The facility is a single-story building located in a residential area with three (3) resident bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Vaid observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Vaid observed knives and sharps located kitchen cabinet, to be inaccessible to three (3) out of three (3) residents in care. LPA Vaid observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to three (3) out of three (3) residents in care. Kitchen sink water temperature was measured at 106.4 degrees F. Kitchen appliances were observed to be clean and in working order. LPA Vaid observed fully charged fire extinguisher. Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed with plenty of seating and lighting. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 1 - 3: LPA Vaid observed all resident bedrooms to contain the required linens, furnishings, and lighting. LPA Vaid observed required auditory devices on exits. con't on LIC 809C Bathrooms: Signs promoting hand washing were observed. Water temperature in resident bathroom#1 was measured at 108.3 degrees F which is within the required 105 – 120 degrees F. Shared bathroom #2 was observed to be clean and water temperature was measured at 107.3 degrees F which is within the required 105 – 120 degrees F. Centrally Stored Medications: LPA observed cabinet located in hallway to locked and inaccessible to residents in care. Two (2) resident medication was reviewed. Backyard: LPA observed plenty of seating and shade. No large bodies of water were observed. Emergency Drills: Proof of last documented fire drill was conducted 04/04/24. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and observed posted Emergency Disaster Plan. Staff Personnel Files: Staff files are maintained at facility. Three (3) staff files were reviewed. Resident Files: Three (3) resident files were reviewed. Admissions agreements, Health Screening, and resident personal rights were observed in files. Liability Insurance & Infection Control Plan: Liability Insurance expires 10/17/2024, and Infection Control Plan was reviewed. No deficiencies were found during visit. Exit interview was conducted with staff S1 and a copy of this report, were provided.the state’s words, verbatim · CDSS document, May 23, 2024