Caring Home Cottage

Type of visit: Required - 1 Year

At 10:15 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by the Administrator, Flor Lobo. LPA explained the purpose of the visit. LPA observed required postings in the entry area and accessible hand sanitizer, gloves, and masks for visitors. LPA was asked to sign in the visitors log and take their temperature. This is a Residential Care Facility for the Elderly (RCFE). A fire clearance was approved on 01/03/2025 for two (2) ambulatory and four (04) non ambulatory residents. At 10:20 a.m., LPA initiated a physical plant tour of the inside and outside of the facility. The following observations were made: At 10:22 a.m., LPA observed the administrator test the hard wired, interconnected, dual smoke and carbon monoxide detectors. Smoke and carbon monoxide detectors were observed to be functioning properly. Kitchen: The kitchen appliances and fixtures appeared functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility. LPA observed some repackaged food that was properly stored in clearly labeled, containers. LPA observed knives and sharps locked in a kitchen drawer inaccessible to residents. The fire extinguisher is located in the kitchen and was observed fully charged with service date 06/02/2025. Common Areas: These included the living area and dining area. The common areas were properly furnished. The couches and the dining table sits the capacity of the facility and were observed in good repair. A fireplace in the living area was properly screened. LPA observed a facility telephone accessible to residents. Overall the facility was clean and clear of clutter. (Continue on LIC809-C) (Continued form LIC809) Bedrooms: There are a total of five (5) resident bedrooms, one (1) of which is shared. Bedrooms were furnished with beds, night stands, chairs, appropriate bedding and linens, and sufficient lighting. Rooms with exit doors had auditory alarms that were observed on and functioning properly. LPA did not observe any tripping hazards. Bathrooms: There are three (3) bathrooms designated for resident use. One (1) is located in a shared bedroom. Bathrooms were properly supplied with hand soap, toilet paper and paper towels. LPA observed non skid matts or non skid shower floors and grab bars. Hot water temperature was taken from one (1) bathroom at 10:43 a.m. and read between 113.9 degrees Fahrenheit. LPA observed night lights in bathrooms, bedrooms and the hallways leading to the bathrooms. Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards and has a covered patio with outdoor furniture. The laundry room leads to the attached garage and is kept locked and inaccessible to residents in care. Detergents and cleaning products are kept in the garage locked. In the garage LPA observe a deep freezer and emergency food and water. Facility / Staff / Resident Files: At approximately 10:56 a.m., LPA conducted a file review of four (4) staff records and three (03) out of three (03) resident records to insure compliance of licensing forms. LPA also reviewed the facility's active Certificate of Liability Insurance, Emergency Disaster Plan and Infection Control Plan reviewed by administrator on 10/01/2025. Facility had conducted a disaster drill with staff regarding power failure, fire and bomb threats on 08/10/2025 and have scheduled to participate for the national Shake Out drill on 11/01/2025 to complete their Q4 drill. LPA's review of LIC500 indicated their is coverage 24/7. LPA observed centrally stored medication, first aid kit and records are stored in a locked closet. At approximately 11:49 a.m., LPA reviewed Centrally Stored Medication Records for completeness. Facility also keeps a Medication Administration Records (MAR). Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 15, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Evelin Rios conducted a Pre-Licensing Inspection at this facility and met with the applicant representative Flor Lobo. The applicant is "CARING HOME COTTAGE". A fire clearance was approved on 07/30/2024 for six (6) ambulatory residents. The facility is a single story house with a total of five (5) bedrooms and three (3) bathrooms. A tour of the physical plant was initiated at approximately 9:00 a.m. and the following was observed: LPA observed required postings through out the facility. KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of emergency and 7-day non perishable supply of food. Knives were observed locked in a kitchen drawer. Cleaning supplies and other toxins are stored in a locked cabinet. BEDROOMS: There are five (5) bedrooms designated for residents' use, all but one (1) are private bedrooms. Residents' bedrooms were furnished with beds, night stand, chairs, dressers, bedding and linens. The bedrooms have sufficient lighting and storage. BATHROOMS: The facility has three (3) shared bathrooms for residents' use. One bathroom is located in the shared bedroom. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured at a range of 113°F to 114.3°F within regulation. LAUNDRY ROOM: The laundry room is was observed locked. Laundry detergents and other cleaning agents were locked in the laundry room. The attached garage is through the laundry room. The garage is used to store extra facility supplies. (continued on LIC 809-C) (continued from LIC 809) Dual smoke/carbon monoxide alarms were tested and observed to be operable, they are hardwired and interconnected. Two (2) Fire extinguishers were observed fully charged with service date 07/25/2024. COMMON AREAS: These included the living room and the dining area. Living room was furnished with chairs and a couch that sit the capacity of the facility. The living room area was furnished with a television, a and a coffee table. There were no visible immediate hazards. There is a working telephone line and internet access to residents. MEDICATIONS: The medication cabinet is located in a closet and was observed locked. A complete first aid kit is located in the medication closet. Staff/Resident Records: Staff and resident records will be kept in the medication closet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. The backyard of the facility has a covered patio and backyard furniture to accommodate the residents. The are drive way in front of the facility could park three (3) cars at one time. Component III was conducted with the Licensee representatives. Pre-Licensing is complete and this facility has no deficiencies. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. Copy of this report.the state’s words, verbatim · CDSS document, Oct 28, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: LOBO, FLOR - Licensee/Administrator Interview Method: Telephone interview On 10/03/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 3, 2024