St. Daniel's Eldercare

Type of visit: Required - 1 Year

***This is an amended Annual Report originally completed on 01/21/2026 under an incorrect facility. Licensing Program Analyst (LPA) conducted a case management visit on 01/28/2026 to create and deliver the annual report reflecting this facility.*** Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Christian Reyes; Caregiver explained the reason for the visit. Deborah Davis, Administrator/Licensee, arrived shortly thereafter. This home is licensed to serve 6 residents ages 60 and over, six (6) non-ambulatory of which two (2) may be bedridden. Facility has a hospice waiver for six (6) residents. There were two (2) residents under hospice care during inspection. Facility Tour & Observations: Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. “No smoking - Oxygen in Use signs” in various locations of the facility. Physical Plant The facility is located in a residential neighborhood and consists of a single-story home. The home includes five (5) resident bedrooms, one (1) caregiver bedroom, and three (3) bathrooms, of which one (1) is a private bathroom and one (1) is designated for visitor use. The facility contains a large, combined living room and dining room area, an additional living room, kitchen, dining area, attached garage, front yard, and a large backyard. (continued on 809C) The front yard includes a long driveway with a walkway leading to the front entrance. A fenced swimming pool is located on the left side of the home. Each resident bedroom was observed to contain the required furnishings, including a bed with mattress, linens, dresser, chair, and adequate lighting. Cleaning supplies and toxic substances were stored under the kitchen sink and were observed to be locked and inaccessible to residents. A Hoyer lift was observed in R1’s room; per the Caregiver, the lift is used only as needed. Bathrooms were observed to be clean and equipped with required grab bars in the showers and near toilets, as well as non-skid mats. Hot water temperatures measured within the required range of 105–120°F, with readings as follows: Bathroom (1) 105.3°F, Bathroom (2) 109.9°F, and Bathroom (3) 119.0°F. Extra linens and towels were available and stored in the hallway closet. Smoke and carbon monoxide detectors were tested and found to be functional. Two (2) fire extinguishers were observed and accessible near the resident’s bedroom area. The backyard provided shaded seating for residents. All passageways and exits were observed to be clear, safe, and unobstructed. Food Service: Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. Health-Related Services & Records: Five (5) residents files were reviewed and contained current required documents Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports with TB/ambulatory status and Rights acknowledgments. Four (4) residents’ medications were reviewed; medications were observed to be centrally stored in a locked hallway cabinet. MAR logs were observed to be current. Disaster Preparedness: Last fire/earthquake drill was conducted on December 23, 2025, with logs available. LIC 610D Emergency Disaster Plan was posted in the living room area. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training: Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Deborah Davis was valid through January 15, 2027. Insurance: Liability insurance was in compliance with an expiration date of March 06, 2026. An exit interview was conducted with Romeo Lumasag , Caregiver. During the inspection, the facility was observed to be following Title 22, Division 6 regulations. No deficiencies were cited at this time. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent annual inspection visit on 3/17/2025 and was greeted by Administrator Deborah Davis. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 03/05/2025 and 01/28/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Deborah Davis 01/15/2027. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. SEE 809-C Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel record reviewed. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) non-ambulatory residents of which five (5) my be bedridden. This facility may retain six (6) hospice residents. Resident Records/Incident Reports: LPA reviewed resident records for six (6) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Mar 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 3/11/2025 and was greeted by Administrator Deborah Davis. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected six (6) resident rooms. LPA Ramirez inspected six (6) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Bedroom#2 is currently unoccupied. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside showers. LPA Ramirez observed no-slip mat in showers. Showers were observed to be wheelchair accessible. Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). During facility tour, it was revealed resident#1 (R1) was released from skilled nursing on 3/5/2025 with home health wound care. Staff interviews and interview with R1’s responsible party revealed R1 currently has a stage 4 wound on their coccyx. R1 is not on hospice at this time. Per Title 22, Division 6, Chapter 8, Article 11. Health Related Services and Conditions- Prohibited Health Conditions- 87616(a)(1)- Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. LPA Ramirez will issue a type A deficiency based this observation, and interviews conducted. Administrator agreed to draft a plan what steps the facility will take to address R1’s prohibited health condition. Due to time restraints, LPA Ramirez will return at a later time to complete annual inspection. One (1) violation was cited. A copy of this report, 809-D and appeals rights was provided via email.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 01/14/2024. LPA was met by Administrator Deborah Davis 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) hospice residents. LPA requested and obtained a copy of Personnel Report (LIC 500), Resident Roster (LIC 9020), and copy of liability insurance. LPA OBSERVATIONS: Tour began at 10:45 am. The Facility is a single-story building in a residential area with six (6) resident bedrooms, two (2) staff bedrooms, two (2) dining rooms, three (3) full bathrooms, kitchen, family room, TV room area, laundry room and attached three car garage. Front Yard: Was clean and well maintained. A pool was observed to be inaccessible to residents. Kitchen/Pantry: LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7 days of non-perishables. Kitchen sink water temperature was measured at 114.4 degrees F. Signs promoting hand washing and social distancing were observed. Sharps were secured in cabinet to the left of kitchen sink and inaccessible to residents. Cleaning solutions and disinfectants were observed to be locked in cabinet directly under kitchen sink and inaccessible to residents. Pantry contained emergency water supply. Dining Room/Family Room/TV Room: Dining rooms were observed to be clean and contained tables and chairs. Family room/TV room area had 7 recliners and additional seating for residents and guests. Signs promoting social distancing and cough/sneeze etiquette were observed throughout this area. Linen Closet: Contained plenty of linens, towels, and hygiene products. Resident Rooms 1 - 6: All contained the required furnishings, linens and were observed to be clean. Rooms were observed to be clean. Bathrooms: Shared resident bathroom# 1 was observed to be clean and contained soap and paper towels. Grab bars were observed near toilet and shower. Water temperature in this bathroom was measured at 113.1 degrees F which is in the required 105 – 120 degrees F. Shared Bathroom #2 water temperature was measured at 114.1 degrees F which is in the required 105 – 120 degrees F. Grab bars were observed near toilet and shower. Private resident bathroom located in resident bedroom #3 was observed to be clean and contained grab bars and non-slip mats in shower. Centrally Stored Medications: Is located near hallway and was observed to secured and inaccessible to residents. First aid kit was observed and inspected. Attached Garage: LPA observed PPE supplies and was inaccessible to residents. Laundry Room: Was inaccessible to residents and laundry detergent was locked in cabinet above washer and dryer. Administrator certificate was observed for Deborah Davis with an expiration date 01/15/25. Last fire drill was conducted on 11/03/2023. LPA observed carbon monoxide in hallways. Smoke detector is hard wired and tested during visit. Several fire extinguishers were observed in the facility and were fully charged. No deficiencies were cited during visit. Exit interview was conducted with Administrator Davis and a copy of this report was provided via email due to printer problems.the state’s words, verbatim · CDSS document, Jan 14, 2024