Terra Linda Christian Homes, Inc. #4

Type of visit: Required - 1 Year

At approximately 12:30 PM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Designee Bella Nachor. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Hospice waiver for four (4), with three (3) Hospice residents currently in care, and is approved for all non-ambulatory residents. At approximately 12:40 PM, LPA initiated a tour of the facility with Designee and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 10/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperatures measured 114.6- degrees and 111.2 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed a pool in the backyard that is fenced and locked. Per staff, pool is not used by residents and is maintained by landlord. During this visit LPA observed a local high school volunteer group speaking with and participating in resident activities under supervision of staff. Per staff, the volunteers come by once or twice a week, including weekends, and are well liked by the residents. Continued LIC809C... Continued from LIC809... Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. Facility conducts quarterly disaster drills, and the most recent drill was conducted 9/25. LPA observed facility's infection control plan and emergency disaster plan which was last updated 9/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 1:30 PM LPA conducted a review of four (4) resident records. All required documentation present. At approximately 2:00 PM LPA conducted review of two (2) staff records. All required documentation present. At approximately 2:15 PM LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. Ana Bautista Administrator Certificate 7000300740 expires 3/12/2027. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Designee, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Oct 27, 2025

Type of visit: Required - 1 Year

11/18/2024, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 6 residents in care. LPA was greeted by staff member, Michell Literato. Administrator, Bella Nacho arrived shortly after. Facility approved/cleared for 6 non-ambulatory, and hospice waiver for 3. At approximately 1:50 pm, LPA and Administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Medications were found to be centrally stored. All rooms were equipped with lighting, night stand, and chest of drawers. All rooms were in good repair. Extra hygiene products and linens were available and located in the hallway closet. Water temperature in sinks accessible to residents in care were measured at 106.4 and 114.6 degrees F within the range of 105 to 120 degrees F. Fire extinguishers were last inspected 08/2023 and were found to be charged. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility conducts quarterly fire and emergency evacuation drills with the last one being conducted on 09/07/2024. Toxins, sharps and other items that could pose threat if available to residents were located under the kitchen sink and were found to be secured. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted a review of 4 resident records. All records had the required documentation. LPA conducted review of 3 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. continued on LIC809-C No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Current Lease Exit interview conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 18, 2024

Type of visit: Required - 1 Year

At approximately 10:00AM on 11/19/2023, Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Required - 1 Year Visit Inspection and met with Administrator, Ana Bautista. Facility currently has 5 residents, and serves residents with dementia. Facility has a plan of operation for dementia care and programming. Upon arrival at the facility, LPA had temperature checked and answered a standard COVID-symptom questionnaire. LPA conducted a walk-through of the facility and observed the following: All staff present were observed to be wearing a mask. The facility was found to be clean andt a comfortable temperature of 71 F with all exits free from obstruction. Facility submitted their Mitigation and Infection Control Plans to Community Care Licensing (CCL). Fire extinguisher was last serviced on 08/30/23. Smoke and carbon monoxide detectors were tested and operational. The fire alarm system was last inspected and serviced 08/2023. The last facility fire and evacuation drill was conducted on 10/01/2023. The water temperature measured between 105-118 F which is within regulation. There were ample perishable and non-perishable foods as required by regulation and foods were stored as required: sealed and dated. Bathrooms were furnished with soap, paper towels and covered trash containers. There was an ample supply of clean linens. Beds were made with required linens, including mattress pad covers, and had plenty of blankets for the colder weather ahead. Continued on 809-C.. Continued from 809 LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Control of Property (Renewal of Lease) Liability Insurance Documents to be submitted to CCL by due date of 12/5/2023. No deficiencies found at the time of inspection. No citations issued. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Nov 19, 2023