Peaceful Gardens 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility. LPA met with the Administrator Gregg Knapp and explained the reason of visit. The facility is licensed as Residential Care for Elderly (RCFE) to serve six (6) non – ambulatory residents, ages from 60 years old and above. The facility has approved and increased to three (3) hospice waivers on 01/10/2023. Dementia plan is in place. Facility annual fees are current. The facility consists of four (4) bedrooms, two (2) bathrooms, a kitchen, dining room, living room, back yard with shade, and attached garage. The following CARE tool domains were reviewed during this visit: Infection Control: Sufficient PPE supplies and an Infection Control Plan maintained at the facility were observed and in compliance. Physical Plant & Environment Safety: Physical plant tour was conducted. Residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The backyard, outdoor and passageways were free of obstruction and debris/hazards. Storage areas for cleaning solutions, toxins, knives, and hazardous items were kept in a locked cabinet and were inaccessible to residents. (-Continued on the LIC809-C) Water temperature was tested and the temperatures were between 105.8 to 109.1 degrees F., which is in compliance with regulations. Smoke detectors and carbon monoxide detectors were operable. Fire extinguishers were observed and fully charged. Operational Requirements and Disaster Preparedness: Facility has an activity area furnished for outdoor use. Fire drills were conducted quarterly. Staffing and Personnel Records- Training: There appears to be sufficient staffing at all times in the facility. Staff files were reviewed and in compliance. Administrator certificate is current with the expiration date on 06/16/2028. Resident Rights-Information and resident Records-Incident Reports: Facility provided telephone landline and internet for the residents. Resident rights posters and reporting posters were displayed within the facility. Food Service: The kitchen was observed to be clean. Two (2) days of perishables and one-week (7) days of non-perishables food supply were observed. Health Related Service: Medication was properly labeled, centrally stored, and in their original containers. Incidental Medical & Dental and Emergency Intervention: Staff designated to administer medication have the proper training on file. Exit: No deficiencies were noted during this visit per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Administrator Gregg Knapp. Copies of LIC 809s were provided.the state’s words, verbatim · CDSS document, Sep 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual inspection visit and was greeted by a caregiver and the purpose of the visit was explained. Administrator Gregg Knapp arrived shortly after to assist with the facility tour. The facility is single story home located on a residential street in Glendora. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Disinfectants, cleaning solutions, poisons were observed to be secured and inaccessible to residents in care. Smoke detectors observed in hallways were tested and are operable. Three (3) fire extinguishers observed, last serviced in 2025. All resident bedrooms inspected contained required furniture, linens and lighting. Linens were observed to be in good repair. Surplus linens and PPEs located in the hall closet. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA observed grab bars near toilets and inside showers and observed no-slip mat in showers. Centrally stored medications were observed secured in a locked cabinet located in the kitchen. Kitchen was observed clean and free of pests. Sufficient supply of nonperishables for one week and perishable foods for a minimum of two days were observed. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Sharps secured in a located kitchen drawer. continued on LIC 809C continued from LIC 809 Living room and dining area were observed clean and free of obstructions with sufficient seating. LPA observed puzzles, blocks, memory games and coloring books in living room area. There are no pools or large bodies of water. There is a covered patio located in the backyard with sufficient seating for residents in care. Passageways and exits are free of obstructions. Five (5) resident and four (4) staff files were reviewed. S1 and S2 did not have health screening with TB clearance in their file. Deficiency cited. Attached garage has laundry area. Washing machine and dryer were operable at the time of visit. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D. Exit interview held and a copy of the report along with appeal rights were provided to the Administrator Gregg Knapp.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit and was greeted by Administrator Gregg Knapp. 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 accessible to residents in private bathroom#2, located in resident bedroom#3. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observe postings encouraging proper handwashing etiquette in restrooms. 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. 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). Planned Activities: LPA Ramirez observed puzzles, blocks, memory games and coloring books in living room area. Residents Rights-Information: LPA Ramirez observed the following posting in common area of the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 03/06/24. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. See 809-D 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 and delay egress perimeters were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored facility cabinet. LPA Ramirez observed three (3) containers of medication sitting on top of kitchen counter and accessible to residents and visitors. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA Ramirez observed six (6) out of the six (6) residents MAR did not reflect documentation of continuing medication care administered from 8/14/24 through 8/16/24 (AM only). The facility provides incidental medical services. LPA Ramirez observed six (6) out of the six (6) residents had their medications transferred from their original container and into a 7-day pill box organizer. Staffing: Administrator Certificate for Gregg Knapp expires 06/16/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for two (2) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance for three (3) out of the three (3) personnel records reviewed. LPA Ramirez did not observe job applications for three(3) out of the three (3) personnel records 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. This facility may retain no more than three (3) hospice residents. There are three (3) residents under hospice care. Resident Records/Incident Reports: LPA reviewed Resident files for six (6) residents. Resident files 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 for five (5) out of the six (6) residents in care. R2 did not have signed Admission Agreement, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, and Resident Rights. Some information was missing on these forms. Deficiencies were observed today. Exit interview was conducted. A copy of this report, 809-D, LIC 9120 and appeals rights was provided.the state’s words, verbatim · CDSS document, Aug 16, 2024

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.