Queen Mary Guest Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six residents, of which six may be non-ambulatory, and a hospice waiver for two. As of today, there are five residents admitted to the facility. There are six bedrooms (5 resident & 1 staff) and two restrooms available. There’s a living room space, a dining space and a detached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured in between 110.2 – 116.2 degrees F. Kitchen: Sharps are kept locked cabinet under the sink. Cleaning chemicals are in a locked cabinet in the main hallway. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. Client & Staff Files: Resident and staff files stored in a locked cabinet in the kitchen. File Review: 3 of 5 resident files were reviewed during the visit, and three staff files were reviewed. Medications/First-Aid Kit: Resident medications are stored locked medication cabinet in the kitchen. A first aid cabinet with first aid supplies and first aid manual was observed. Medication Review: 3 of 5 resident medications were reviewed during the visit. No discrepancies were noted. Medication are being administered as prescribed. Continued on LIC809C Linens & Hygiene Supplies: Additional linens were observed in a hallway closet near the main bathroom. Garage Area: The garage is used primarily as a storage area for facility items. Walkers, wheelchairs, tools, and incontinent care supplies were some of the items observed. Backyard/Exterior: The backyard is clean and very well organized. Walkways are free of obstruction. A table with some chairs was observed under a shaded patio area. There’s a laundry room out in the backyard area with a washer and dryer. In the laundry room, LPA observed an emergency supply of food and water, and emergency supplies like clothing, blankets, and incontinent care items in a box ready to go in the event of an emergency. Bodies of Water: None. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted on the base of the stove. An emergency evacuation drill: Was conducted January 25, 2026. Evacuation drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted are available for review on the main postings board in the dining room Additional Comments: Facility contact information was reviewed during the visit. Deficiencies observed during the inspection are being cited. An exit interview conducted, and a copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, Feb 18, 2026

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) Hanna Gough arrived at the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Evangeline Bruno and discussed the purpose of the visit. The facility currently has six residents in care. The facility is a one story home with three resident bedrooms, one staff room, two bathrooms, living room, kitchen, dining room, laundry room, and detached two car garage. Facility appears clean, safe and sanitary. LPA observed the residents napping and watching tv. LPA observed the kitchen to be clean and free of vermin. LPA observed a two day perishable and seven day nonperishable food supply on hand. LPA observed the knives to be locked and made inaccessible to residents in care. LPA observed toxins to be locked and made inaccessible to residents in care. LPA observed the centrally stored medication to be locked in a kitchen cabinet and made inaccessible to residents in care. LPA observed a fire extinguisher in the kitchen to be charged and with a service date of March 10, 2025. LPA observed the restrooms to have non-slip mats in the shower, grab bars and toilet paper. LPA tested the water to be between 101.9 and 102.2 degrees Fahrenheit. LPA observed a clean supply of linens in the hall cabinet for resident use. LPA observed all resident bedrooms to have the required components and furnishings. LPA observed the emergency food and water supply to be located in the laundry room. LPA observed the garage to be locked and made inaccessible to residents in care and is used for storage. LPA observed the backyard to have a shaded seating area for resident use. LPA observed that the backyard was free of debris and obstructions. LPA and AD tested the carbon monoxide and smoke detectors and they were found to be operational. Continue on LIC809C LPA reviewed staff files and no discrepancies were observed. LPA reviewed resident files and one of six residents do not have a medical assessment on file and six of six residents do not have updated needs and services plans. LPA observed resident medication and no discrepancies were observed. LPA advised AD to document medication beyond monthly audits and to keep record. LPA observed the last fire drill was conducted on January 1, 2025. All staff present are background cleared and associated to the facility. Based on observations made during today’s inspection deficiencies and technical violations are being given per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Evangeline Bruno and a copy of this report along with LIC809D, LIC858, LIC9102 and appeal rights were given the time of the inspection.the state’s words, verbatim · CDSS document, Sep 23, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Licensee/Administrator (AD) Evangeline Bruno has a current Administrators certificate that expires August 27, 2024. Queen Mary Guest Home II is a one-story community with 4 bedrooms and two bathrooms. The facility capacity is 6 and the census was 5 during the annual visit. All residents were observed in the living room or in their bedroom during the visit. During the inspection, LPA Haley observed all resident bedrooms and bathrooms. All resident bedrooms had all the requirements and were in compliance with regulation guidelines. Resident bathrooms were in compliance as well. Hazardous cleaning items were locked under the sink and grab bars were tightly secured to the wall. Hot water temperatures were measured in both bathrooms. In bathroom #1 hot water measured at 120.0 degrees Fahrenheit, and in bathroom #2 hot water measured at 118.7 degrees Fahrenheit. In the hallway, next to bathroom 1, LPA Haley observed cabinets with clean linen. In the hallway there was a locked closet where hazardous cleaning supplies are kept. There was a carbon monoxide detector in the hallway mounted on the wall in between the caregiver room and a resident room. In the kitchen knives and sharp objects are locked under the sink. There was a perishable food supply that meets the regulation requirements. In the hallway next to the front door there was a supply of non-perishable food items. Continued on LIC809C In the cabinets above the counter, there were locked cabinets with resident medication and first aid supplies that meet regulation requirements. There was a fully charged fire extinguisher in the kitchen and a carbon monoxide doctor mounted on the wall. The backyard was clean, organized and walkways were free of tripping hazards. There is a small shed with a washer and dryer, a patio area with a table and chairs. The garage is used to store various items. LPA Haley observed facility items like diapers, walkers, bedframes, TVs, and various tool. Smoke detectors were observed in all resident rooms, the hallway, and living room. All were tested and all were operational. An emergency evacuation drill was conducted January 2, 2024 and the second drill will be conducted soon. No deficiencies are being cited as a result of today’s visit. An exit interview conducted and a copy of this report was provided to Licensee/Administrator Evangeline Brunothe state’s words, verbatim · CDSS document, Mar 14, 2024