Mom & Dad's House-Cottage

Type of visit: Required - 1 Year

On 10/08/2025 at 11:00am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one (1) year annual inspection. LPA met with Ivonne Meader (Administrator) and Elsa Roman (Assistant Administrator) the purpose of the visit was discussed. Facility is licensed to serve 6 non-ambulatory residents and an approved for six (6) hospice waivers. The six (6) of the residents are diagnosed with dementia, one (1) hospice, zero (0) home health resident and zero (0) bedridden resident. The facility has a current administrator certificate (#7033600740) for Ivonne Meader valid from 08/20/2024 -08/19/2026 .The facility fees are a at $0 (paid on 10/06/2025 ; confirmation # 983254).The facility has liability insurance with Sunland Risk Retention Group with each occurrence at $1,000,000 and general aggregate at $3,000,000 (policy #SRRG2025-191) effective date 08/15/2025 - 08/15/2026. The disaster drill was conducted on 10/03/2025 (for power outage). The facility is a two (2) story home consisting of: (6) resident bedrooms, (2) full bathroom, (2) resident toilet rooms, (1) living/entry room, (1) dining room/tv/activity room, (1) kitchen, (1) detached garage with extra refrigerator, (1) laundry room, and (2) hallway closets. The second floor consist of (1) staff bedroom, (2) staff bathrooms and (1) office room. The outside of the facility provides an (3) outdoor shaded area with a front and backyard. Report continues on LIC 809-C Between the hours of 11:29pm - 1:00pm, LPA conducted a records review of (6) client records, (6) staff records, and reviewed the facility disaster plan. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (6) Client Medication Administrations Records and did not observed any discrepancies at the time of visit. Between the hours 1:24pm -1:41pm, LPA toured the facility with Elsa Roman (Assistant Administrator) and observed resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 112.1°F in bathroom #1 ,114.8 °F in bathroom #2, 109.4°F in half-bathroom #1, 113.4°F in half bathroom #2: & Kitchen: 113.5 °F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. Exit interview conducted with Ivonne Meader (Administrator) and Elsa Roman (Assistant Administrator).the state’s words, verbatim · CDSS document, Oct 8, 2025

Allegation investigated: Resident sustained an unexplained fracture while in care.

On 08/07/2025 at 12:15 PM, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent visit at this facility to deliver the complaint findings. During today's visit, LPA met with Ivonne Meader, Administrator and explained the purpose of the visit. The investigation consisted of the following: An initial complaint visit was completed by the Department on 04/10/2025. LPA requested and reviewed the following documents: Register of Facility Clients/Residents, LIC 601: Identification and Emergency Information (dated 06/16/2024) for Resident 6 (R6), LIC 602A: Physician's Report for Residential Care Facilities for the Elderly (RCFE) – dated 11/22/2024 for R6, Resident Appraisal – dated 07/08/2025 for R6, Appraisal/Needs and Services Plan – dated 07/01/2024, LIC 624 Unusual Incident/Injury Reports – dated 03/28/2025, 10/21/2024, 09/04/2024, and 07/15/2024 and Medical Records (from Memorial Long Beach Medical Hospital - dated 04/17/2025) for R6 received on 04/17/2025. Unsubstantiated The investigation revealed the following: Allegation 1: Resident sustained an unexplained fracture while in care. It was alleged that a Resident sustained an unexplained fracture due to lack of supervision or negligence while residing at the facility. On 07/08/2025 at 10:40 AM, LPA interviewed A1 (Administrator). A1 denied the allegation and stated that R6 injury was reported promptly to the physician, the responsible party was notified, and the incident occurred when staff was not present in the immediate area, but there were no signs of abuse or neglect. A1 indicated that staff follow protocol, and the resident had a history of unsteady gait despite using a walker. On the date of the incident, R6 was sitting in his wheelchair at the dining table. Between 9:30 AM and 10:15 AM, LPA interviewed 2 staff regarding the allegation: 2 of 2 staff denied the allegation. Between 8:35 AM - 9:13 AM, LPA interviewed 3 residents: 2 out of 3 residents denied the allegation. 1 out of 3 residents was unaware of the allegation. LPA conducted a records review on 06/25/2025, between the hours of 11:06 AM - 11:45 AM & 08/07/2025, between the hours of 9:20am - 9:30am and observed the following: The LIC 624: Unusual Incident/Injury Report dated 03/28/2025, R6 was sitting around the table when S1 heard a sound coming from the dining room and S1 witnessed R6 on the floor. Staff called 911 and notified the assistant administrator. The assistant administrator called R6's POA who was able to come to the facility at the same time as paramedics. POA insisted that R6 was okay and did not need transportation to the hospital. Paramedics agreed and he was not transported to the hospital. The resident was admitted to the facility on 06/18/2024. According to the Physician’s Report, the resident has been diagnosed with dementia, is non-ambulatory, and requires assistance with grooming, bathing, and feeding. Report continues on LIC 9099-C The report further notes that the resident experiences generalized muscle weakness, uses both a walker and wheelchair, and is able to follow instructions and communicate his needs. A Resident Appraisal dated 07/08/2024 documents additional conditions, including left hip arthritis, episodes of sundowning, and frequent hallucinations. According to the resident’s Needs and Services Plan, the resident requires assistance with all Activities of Daily Living (ADLs), has mobility limitations due to physical and cognitive impairments, and is at increased risk for falls. The plan includes supervision for safety, cueing and support for memory-related deficits, and assistance with medication management, hygiene, and mobility transfers. The LIC 624 – Unusual Incident/Injury Report was submitted to document a significant incident resulting in the resident’s hospitalization. The form outlines the date, time, nature of the injury, immediate response by facility staff, and notifications made to the resident’s responsible party and licensing agency. Per the Memorial Care Emergency Department to Hospital Admission form, the resident was admitted to the hospital on 03/28/2025 at 7:28 PM under Trauma status. The admitting diagnosis was a left displaced femoral neck fracture, requiring further treatment. Based on interviews and record review conducted there is no not enough evidence to support that the facility staff did not provide enough supervision to the resident therefore the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Ivonne Meader, Administrator & copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 7, 2025 · control 11-AS-20250401104354

Allegation investigated: Staff mismanaged resident's medication

On 05/21/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Administrator/Licensee, Ivonne Meader and Administrator, Elsa Roman, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: During today's visit, LPA inspected the facility, conducted a medication review, interviewed Staff S1-S4, interviewed residents R1, R3-R5, interviewed Resident’s R1, R2, and R5’s Responsible Party W1- W3, and received documents pertinent to the investigation. The following documents were received and reviewed Staff Roster, Resident Roster, Physician’s Reports, Physician Orders, Centrally Stored Medications, Medication Exceptions, PRN Report, Staff Training Logs, and Medication Administration Record (MAR) for March and April 2025. The investigation revealed the following: Unsubstantiated Allegation: Staff mismanaged resident's medication The allegation alleges that resident’s medication is not properly logged or not logged in the resident file. LPA observed centrally stored medications secured in a locked medication cart. All medications were observed in their original packaging. From 11:51 AM to 12:32 PM, LPA reviewed Resident R1-R6’s Physician’s Orders and Centrally Stored Medications and observed the medication bubble packs are consistent with the dates and listed medications from the pharmacy and physician. LPA received and reviewed resident Medication Exception that indicates when, why, and who provided or withheld medication. LPA received and reviewed residents PRN Report that indicates the date and time a PRN was given, the strength, reason, result and who gave the medication. LPA received and reviewed the Staff training regarding medication administration and medication procedure regarding physician orders, documenting, and labels. LPA observed staff conduct 7 hours of medication training annually. During interviews with Staff S1-S4, were asked if residents receive their medications as prescribed, four (4) out of four (4) stated residents receive their medications as prescribed. Additionally, Staff S1-S4 were asked if there has been any mismanagement of medications, four (4) out of four (4) stated no, there have been no medication mismanagement and medications are provided as prescribed. During interviews with Residents R1, R3-R5, were asked if they receive their medication as prescribed, four (4) out of four (4) stated yes, they receive their medications as prescribed. During interviews with Resident R1, R2, and R5’s responsible party and/or family member W1- W3 were asked if their resident receives their medications as prescribed, three (3) out of three (3) stated their residents receive their medications as prescribed. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. LPA did not observe or cite any deficiencies during today's visit. An exit interview was conducted with Licensee/Administrator, Ivonne Meader, and Administrator, Elsa Roman, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 21, 2025 · control 11-AS-20250513143305

Type of visit: Required - 1 Year

On 10/09/2024 at 8:45am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one (1) year annual inspection. LPA met with Ivonne Meader (Administrator) and the purpose of the visit was discussed. Facility is licensed to serve 6 non-ambulatory residents and an approved for six (6) hospice waivers. The five (5) of the residents are diagnosed with dementia, zero (0) hospice, one (1) home health resident and zero (0) bedridden resident. The facility have a balance of $0 for annual fees. The last fire drill was conducted on 09/22/2024 The Certificate of Liability is valid from 08/15/2024 - 08/15/2025. The facility is a two (2) story home consisting of: (6) resident bedrooms, (2) Full bathroom, (2) resident toilet rooms, (1) living/entry room, (1) dining room/tv/activity room, (1) kitchen, (1) detached garage with extra refrigerator for staff and 330 meals which expires in 20 years, (1) laundry room, and (2) hallway closets. The second floor consist of (1) staff bedroom, (2) staff bathrooms and (1) office room. The outside of the facility provides an (3) outdoor shaded area with a front and backyard. LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 106.0 F (bathroom #1), 112.3 F (bathroom #2), 109.6 (half-bathroom #1), 108.0F (half bathroom #2) and 115.1F (kitchen). Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Report continues on LIC809-C Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA conducted a electronic records review of (5) client records, (5) staff records, and reviewed the facility disaster plan. All client & staff records were organized, and completely up to date . The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (5) Client Medication Administration Records and did not observed any discrepancies at the time of visit. During todays visit LPA did not observe any deficiencies and an exit interview conducted with Ivonne Meader, Administratorthe state’s words, verbatim · CDSS document, Oct 9, 2024

Type of visit: Required - 1 Year

On 12/12/2023 at around 10:00 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Licensee/Administrator Ivonne A. Meader. LPA explained the purpose of the visit and was accompanied by the Administrator inside and outside the facility during this inspection. This facility is licensed to serve 6 non-ambulatory adults ages 60 and above, of which 6 may be in hospice care. A total of 6 non-ambulatory residents are currently residing in this facility. The Annual Licensing Fees are current. The facility is a two-story house located in a residential street. The first floor consists of 6 resident bedrooms, 2 resident bathrooms, 2 resident toilet rooms, 1 living/entry room, 1 dining/tv/activity room, 1 kitchen, 1 detached garage, 1 laundry closet, and 2 hallway closets. The second floor consist of 1 staff bedroom, 2 staff bathrooms, 1 office room. The outside premises consist of several outside shaded seating areas in the front and backyard. Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last fire, earthquake, and disaster drill was conducted on 9/28/2023. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. There are several fire extinguishers on the premises, and they were last serviced on 09/14/2023. There is a videoconferencing device (ipad) dedicated for client use in the dining/tv/activity room. 6 out of 6 resident’s bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 5 staff records were reviewed, 5 out of 5 staff records had current First Aid Certificates, Criminal Record Clearance, Job Applications, Tuberculosis Test, Facility Trainings/Drills, and signed Employee Rights. 5 resident records were reviewed and, 5 out of 5 resident records had Admission Agreements, Medical Assessments, Consent Forms, Weight Record, Emergency Information, Appraisal & Needs Service Plan, Tuberculosis Test, Centrally Stored Medication Destruction Record, and Personal Rights. No deficiencies are being cited based on LPA observations, interviews conducted and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted and a copy of this report was left with the Administratorthe state’s words, verbatim · CDSS document, Dec 12, 2023