St. Cecilia's Senior Home IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual inspection visit. LPA met with Cholly Sason and discussed the purpose of today’s visit. Tiffany Vander Poorten Administrator arrived shortly after. The facility is a single-story home located in Glendora, licensed to serve (6) non-ambulatory residents age range 60 and over. The facility has an approved Dementia Care Plan and a Hospice Waiver approved for (6) residents. LPA obtained a copy of a current liability insurance coverage. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. Smoke detectors were observed throughout the facility. Carbon monoxide detector is located in the hallway, was tested and operable. Two (2) fire extinguishers were observed, one located near the kitchen/dining area, and one located inside the laundry room. Last fire drill was conducted on 01/07/26. Bedrooms have the required furniture. Extra, clean linens were observed in a hall closet. Bathrooms have non-skid surfaces and grab bars. Hot water temperature measured at 109.4°F and 1009.5°F in the hallway bathrooms. Staffing: Facility is adhering to staffing requirements. continued on LIC809C Personnel Records-Training: LPA reviewed four (4)staff files. Staff have current First Aid/CPR certification, fingerprint/background clearance, and personnel record. 1 out of 4 files did not have a health screening for review. Deficiency cited. Resident Rights-Information: Resident rights are posted and are included in Resident files. Planned Activities: Activity provides planned activities. This facility also provides internet access to the clients. Food Service: There is sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed files for six (6) residents. Resident file has the required documents. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment and Preplacement Appraisal Information, Resident Pre-Appraisal. Resident Rights were observed. Disaster Preparedness: The facility has a Disaster Preparedness plan in place, last reviewed 2/26. LPA obtained a copy for facility file. Health Related Services/Incidental Medical Services: The medications centrally stored and locked. Medications are administered as prescribed. Physician's orders for bed rails were observed. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during today’s visit are documented on the LIC809D. Exit interview held and a copy of this report along with appeal rights were provided to Tiffany Vander Poorten.the state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elizabeth Irra conducted an annual inspection visit. LPA met with Cholly Sason and discussed the purpose of today’s visit. Tiffany Vander Poorten (Administrator) arrived at approximately 9:05 A.M.. This home is a single-story home with a fire clearance for (6) non-ambulatory residents. This home also has an approved Dementia Care Plan and a Hospice Waiver approved for (6) residents. There are currently (2) residents receiving hospice care. There are (3) residents receiving Home Health Agency services. LPA obtained a copy of a current liability insurance coverage. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an Infection Control Policy in place and was observed to be posted. Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detector (located in the hallway) observed. The fire extinguishers were observed and appeared to be full (one located near the kitchen/dining area and one located inside the laundry room). Last drill was conducted on 01/22/25. Bedrooms have the required furniture. Ample supply of food (perishable and non-perishable) was observed. Ample linen supplies were also observed. Bathrooms have non-skid surfaces and grab bars. Hot water temperature measured at 106.8* and 107.4 * in the hallway bathrooms and 106.5* in the bathroom inside bedroom # 4. ***Refer to LIC 809C for the continuation of this report***. Staffing: Facility is adhering to staffing requirements. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for S-1 through S-5. Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Resident Rights-Information: Resident rights are posted and are included in Resident files. Planned Activities: Activity provides planned activities. This facility also provides internet access to the clients. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #5 (R-5). Resident files are maintained at the facility. Resident file has the required documents. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment and Preplacement Appraisal Information, Resident Pre-Appraisal. Resident Rights were observed. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. Health Related Services/Incidental Medical Services: The medications are stored and locked. Medications are administered as prescribed. Exit interview conducted, copy of appeal rights and a copy of this report was provided to Tiffany Vander Poorten (Administrator).the state’s words, verbatim · CDSS document, Apr 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst's (LPA's) Val Maldonado and Tyler Reyes made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA's Maldonado and Reyes met with Administrator, Tiffany Vander Poorten, and explained the purpose for the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Administrator, observed the facility food supplies, reviewed (6) resident medications, (6) resident files, (3) staff files, and conducted interviews with (3) staff, and attempted interviews with (6) residents. The facility is a single-story home, operating as a Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. There is a fire clearance approved for (6) non-ambulatory residents. It has an approved Dementia Care Plan and a Hospice Waiver approved for (6) residents. There are currently (2) residents receiving hospice services. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review. The facility has an active and current liability insurance policy on file. LPA observed all resident bedrooms to have the required furniture, sufficient lighting, and closet/storage space. There are (2) full bathrooms in the home- both equipped with required grab bars and non-skid mats for the shower. (4) residents beds were observed with bed rails and had the required written physician's orders on file. The hot water was tested and measured between 109.8*F-111.9*F, which is in compliance. Food supplies was observed and was sufficient as required. Emergency food supplies and water were available. There were no bodies of water observed on the premises. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to residents in care. The last fire drill was conducted in January 2024. Auditory devices were observed at all entrances/exits of the home and were operational. (6) resident files and (3) staff files were reviewed and observed to be complete with all required documentation. (6) resident medications were reviewed and were observed to be documented properly and given as prescribed. No deficiencies were observed or cited during today's visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 5, 2024