St. Cecilia's Senior Home III

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual. LPA was greeted by staff and reason for the visit was explained. Licensee arrived shortly after. The facility is licensed to serve six (6) residents age 60 and over of which six (6) may be non-ambulatory, with a hospice waiver for six (6). The facility is a single-story home located in a residential area of Glendora. The home consists of (4) resident bedrooms, (3) bathrooms, a living room, a dining area, a kitchen, a family room, an attached garage/laundry, a front yard, and a backyard with a pool. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: The front and backyard are well maintained. There is a pool in the backyard. The pool has a perimeter fence with a gate that opens outward and self-latches. There is a covered patio located in the backyard with sufficient seating for residents in care. Passageways and exits are free of obstruction. The water temperature was tested in the bathrooms and measured within the required 105 degrees F - 120 degrees F. LPA observed grab bars and non-skid mats in both the bathrooms. continue LIC809 Smoke detectors were observed throughout the facility and are operable. There is a carbon monoxide detector located near the dining area. There were fire extinguishers throughout the home. Last emergency drill way conducted April 2026. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked under the kitchen sink and are inaccessible to residents. Cleaning supplies and disinfectants are locked in a cabinet in the garage and are inaccessible to the residents. Sufficient supply of 2 days perishable and 7 days non-perishable foods were observed. Dining area and living room were observed to be clean and free of obstructions and have sufficient seating for residents in care. Medications are centrally stored in a cabinet near the kitchen. Medications are documented properly and given as prescribed. Resident bedrooms have all require furniture which includes, for each resident, a bed, a chair, night stand, a lamp, or lights sufficient for reading. Bed linens were clean and in good repair. There is closet space for clothing and other belongings. Hall closet contained extra, clean linens. Six (6) resident and five (5) staff files were reviewed and were observed to contain required documentation. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were cited during today’s visit. Exit interview held and a copy of this report was provided to Tiffany Vander Poorten.the state’s words, verbatim · CDSS document, Aug 7, 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 Glenda Precillas and explained the reason for the visit. Licensee arrived shortly after. The facility is licensed to serve 6 residents age 60 and over of which 6 may be non-ambulatory with a hospice waiver for 6. The facility is located in a residential area and consist of a single home with (4) resident bedrooms, (3) bathrooms, a living room, a dining room, a kitchen, a family room, an attached garage/laundry, a front yard, and a back yard. The following domains were reviewed during this visit: Infection Control: Facility maintains a copy of the infection control plan. Staff #2-4's medical assessments did not have results for TB test. Operational Requirements: Facility maintains a plan of operation, fire clearance. Facility is operating within the limitations of their license. They currently don't any residents under hospice care, or bedridden. A current liability insurance was observed and a copy was obtained. Physical Plant/Environmental Safety: LPA toured the facility with Glenda Precillas and observed the following. Facility was observed clean and in good repair. Living room, dining room, and family room were observed with furniture in good repair. Living room has a covered fireplace. Kitchen was observed clean. Cleaning supplies and sharps are maintained locked under the sink. Refrigerator/freezer and pantry were observed. Medication cabinet is located in family room. Four (4) resident rooms were observed with sufficient lighting, required furniture and bedding supplies. Half bed rails were observed in residents' beds and physician's orders were on each residents' file. Three (3) bathrooms were observed in good repair and clean Water temperature was tested in each bathroom sink and tested at 105.3 degrees F., which is within the required 105-120 degrees F. Oxygen tanks were observed in bedroom #3, no smoking sign was not observed. A fire extinguisher was observed. Carbon Monoxide/Smoke detectors were tested and are in working condition. Laundry area was observed in good repair. Two large bodies of water were observed, a pool and a pond. The pool has a 5ft fence surrounding it and the pond has a screen covering it. Passageways were clear of obstructions. Staffing: Administrator certificate was reviewed for Josiah Poorten #7020881740 exp. date: 11/11/25. 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; health screening, background clearance, personnel record, and training for each staff. Two staff were interviewed. Resident Rights/Information: License, Let us Know (PUB 475), Ombudsman, personal rights posters were posted in the family room. Planned Activities: Facility provides activities such as puzzles, books, board games, music entertainer. 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 garage. Kitchen was observed clean and free of pest. Incidental Medical and Dental: Facility provides assistance with medical/dental arrangements and with medication assistance. Medications were observed stored in locked medication closet. LPA reviewed medication for 5 residents. Resident Records/Incident Reports: LPA reviewed 5 residents files, each contained admission agreement, medical assessment, TB clearance, pre-appraisal, and appraisal. Two resident were interviewed. Disaster Preparedness: LPA reviewed emergency disaster plan LIC 610E(3/19) last reviewed on 7/14/25. Emergency drills are conducted quarterly, last emergency drill was conducted on 7/14/25. Residents with Special Health Needs: Facility is not serving residents with Special Health Needs. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Glenda Precillas and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 25, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with licensee Tiffany Vander at approximately 9:05 AM and explained the reason for the visit. The facility cares for elderly/dementia residents and is approved to care for 6 hospice residents. There are currently 0 residents on hospice. The 1-story facility consist of the following: Four Bedrooms, 3 Resident Bathrooms, dining room, living room, TV room, office, and patio/deck area and attached garage. All resident bedrooms were toured. Bedrooms have the required bed, bedframe, linen, dresser, light, and closet space. During time of visit auditory devises were not working deficiency cited. Resident bathrooms were toured, and the hot water was 106-108.5 degrees which is within the required 105 - 120 degrees. Bathrooms have the required grab bars in the shower and near the toilet. The kitchen was inspected. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 45 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There is an extra freezer and refrigerator in garage filled with more food. All the appliances are clean and are operating properly. The sharp knives are located in a kitchen drawer that is inaccessible to residents. Cleaning supplies and chemicals are stored in a locked kitchen cabinet and in the garage. There is an additional refrigerator in the garage. The common areas include the living room and dining area. There is a fire extinguisher near the kitchen and another near the garage. The backyard has a shaded patio area with patio furniture. There is a pool that has a fence around the entire perimeter. There is also a fishpond that has a net on top to make the body of water inaccessible to residents. Four (4) client files were reviewed and included physicians report and TB clearance .Four (4) Staff files were reviewed. Last fire/earthquake drill was conducted in May of 2024. Infectious control plan was reviewed. Four (4) residents’ medications were reviewed. Medications are centrally stored and locked MAR log is used. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Tiffany Vander.the state’s words, verbatim · CDSS document, Jul 12, 2024