Seniors' Haven

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced annual required visit and inspection of the facility. LPA met with Jorge Adle Mendoza - Administrator and explained the reason for the visit. The facility is licensed to serve six (6) residents ages 60 and above, of whom (6) may be non-ambulatory. Facility has an approved waiver for two (2) hospice residents. At 10:15am, with the assistance of Administrator, LPA took a tour of the physical plant and observed the following. Required postings were observed in the entry area. The smoke/carbon monoxide detectors are hardwired and interconnected. At 11:05 am smoke alarms/carbon monoxide detectors were tested and observed to be functional. The fire extinguisher is located in the kitchen and was purchased on 3/1/2026. The auditory alarms on all exit doors were functional at the time of the visit. Kitchen: Appliances consisted of stove, dishwasher and microwave. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. Knives were stored in a locked drawer in the kitchen. Chemicals and detergents were stored in a locked cabinet underneath the sink. LPA observed an exit door in the kitchen, leading to the front. Common Areas: The family room and the office are located by the entry. There is a living room and dining a room, furnished with tables, chairs and a television set. There is a double sided fireplace in the family and living rooms; both fireplaces were properly covered by a glass cover. LPA observed a karaoke machine and entertainment area in the living room. Facility offers a land-line telephone, cable and internet access for resident's use. Continued on 809-C Bedrooms: There were four (4) bedrooms, three (3) of which are designated for residents' use. Bedroom #4 is designated as staff room but there is awake staff at night. All bedrooms are were properly furnished with appropriate beddings, chairs, cabinets, linens and have sufficient lighting. Currently bedrooms #2 and #3 are vacant. Bathrooms: There are two (2) bathrooms, one near bedroom# 4 and one between bedrooms #2 and #3. LPA observed functional fixtures, grab bars and non-skid mats in each bathroom. Hot water temperature was measured at 108.9 and 109.7 degrees Fahrenheit. Surrounding Grounds: There were no bodies of water or obstructions on the premises. There is a covered patio with furniture appropriate for outdoor use. There is a locked shed in the backyard. Garage is detached and is currently being utilized as storage. The laundry machines and detergents are kept locked in the garage. There is a ramp leading from the living room to the backyard; there is also a side door in the kitchen and a door in bedroom# 4 leading to the backyard. Facility uses the main entry door as the emergency exit door. Facility conducts quarterly fire/emergency drills, the last drill was conducted on 01/01/2026. Resident Files/Medications: LPA reviewed the records for the one (1) resident. Medications are kept locked in the hallway closed. LPA observed a complete first aid kit and the manual in locked medication cabinet. LPA counted medication for the one (1) resident, for accuracy of administration. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and in compliance with licensing requirements. LPA reviewed the facility liability insurance with expiration dated of 09/07/2026. Administrator Certification expiration date is 12/03/2026. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies were observed during the visit. Exit Interview Conducted / A Copy of the Report Issued to the Administrator.the state’s words, verbatim · CDSS document, Mar 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced annual required visit and inspection of the facility. LPA met with Jorge Adle Mendoza - Administrator and explained the reason for the visit. The facility is licensed to serve six (6) residents ages 60 and above, of whom (6) may be non-ambulatory. Bedroom #3 has an approved waiver for two (2) hospice residents. Currently the facility has no clients in care. At 10:45am, with the assistance of Administrator, LPA took a tour of the physical plant. The facility is a one story structure with four (4) bedrooms, two (2) bathrooms, kitchen, dining area, family room, and living room/office area. Required postings were observed in the entry area. The smoke alarms/carbon monoxide detectors are hardwired and interconnected. At 11:05 am smoke alarms/carbon monoxide detectors were tested and observed to be functional. The fire extinguisher is located in the kitchen and was purchased on 7/1/2024. The auditory alarms on all exit doors were functional at the time of the visit. Common Areas: These included the living room, family room and dining area. LPA observed a double sided fireplace in the family and living rooms; both fireplaces were properly covered by a glass cover. The common areas were properly furnished with tables and chairs for the number of residents. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. Knives were stored in a locked drawer in the kitchen. Chemicals and detergents were stored in a locked cabinet underneath the sink. Continued on LIC 809-C Bedrooms: There were four (4) bedrooms, three (3) of which are designated for residents' use. Bedroom # 3 is designated for hospice residents and bedroom #4 is designated as staff room. All bedrooms are were properly furnished with appropriate beddings, chairs, cabinets, linens and have sufficient lighting. Bathrooms: There are two (2) bathrooms, one near bedroom# 4 and one between bedrooms #2 and #3. LPA observed functional fixtures, grab bars and non-skid mats in each bathroom. Hot water temperature was measured at 120.2 degrees Fahrenheit. Surrounding Grounds: There were no bodies of water or obstructions on the premises. There is a covered patio with furniture appropriate for outdoor use. There is a locked shed in the backyard. The laundry machines and detergents are located in the garage, which is currently used for storage. There is a ramp leading from the living room to the backyard; there is also a side door in the kitchen and a door in bedroom# 4 leading to the backyard. Facility uses the main entry door as the emergency exit door. Resident Files/Medications: Since there have been no residents for over two years, LPA did not review resident records. LPA observed a complete first aid kit and the manual in a locked cabinet, which is designated for medication storage. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and in compliance with licensing requirements. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies were observed during the visit. Exit Interview Conducted / A Copy of the Report Issued to the Administrator.the state’s words, verbatim · CDSS document, Apr 2, 2025

Type of visit: Required - 1 Year

On 4/27/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Jorge Adle Mendoza/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) residents ages 60 and above. Of which (6) may be non-ambulatory. Bedroom #4. Approved hospice waiver for (2). Currently the facility has no clients in care. The facility is a 1 story structure with 4 bedrooms, 2 bathrooms, kitchen, dining area, family room, and living room/office area. LPA toured the physical plant with administrator. There were no bodies of water or obstructions on the premises. A total of (4) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected the carbon monoxide detectors combo were in operable conditions. The water temperature properly measured between 105F. and 120F. Evaluation Report Continues LIC 809-C LPA Iniguez observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning agents, poisons, and sharps objects were locked and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. A review of (0) residents' service files, (1) staff personnel files were checked. (0) Medication Administration Records (MAR) were reviewed. LPA observed the facility's infection control practices. Copy of liability insurance was provided to LPA during this visit. Facility Annual Fess not current. LPA told administrator that the license fees are not current since 3/8/24. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Jorge Adle Mendoza/Administrator.the state’s words, verbatim · CDSS document, Apr 27, 2024