The Beechwood Cottage

Type of visit: Required - 1 Year

On May 29, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator Ines Otbo and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory and has a hospice waiver for six (6) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: six (6) residents bedrooms, one (1) staff bedroom, three (3) bathrooms, an attached 2-car garage, family room, laundry room, office area, dining area, kitchen, and an outdoor covered seating area. LPA Kim toured inside and outside of the physical plant. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident room 1, resident room 2, resident room 3, resident room 4, resident room 5, and resident room 6. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 111.0 degrees F and 116.6 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water and emergency supplies are stored in the garage and in the staff room closet. All mandated inspection control posters were posted. The facility has smoke detectors and carbon monoxide detectors that were operable. The Certificate of Liability Insurance is effective from June 25, 2025, to June 25, 2026. The facility conducts Fire/Safety Drills quarterly and was last conducted on March 26, 2026. Four (4) fire extinguishers were mounted in the kitchen, garage, family room, and in the laundry room, and were last serviced on August 12, 2025. A working telephone (714-255-7917) and tablet device dedicated to the residents both remain available. First Aid Kit contained all the necessary elements. LPA Kim conducted an audit of five (5) residents (R1-R5) files, and seven (7) staff (S1-S7) personnel files, and medication and medication administration records that all were complete and all in order. LPA conducted interviews for three (3) residents and two (2) staff. No deficiencies were being cited for today’s inspection visit. An exit interview was conducted, and a copy of this report was provided to Administrator Ines Otbo.the state’s words, verbatim · CDSS document, May 29, 2026

Type of visit: Required - 1 Year

On August 4, 2025, at 8:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator Ines Otbo and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory and has a hospice waiver for six (6) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: six (6) residents bedrooms, one (1) staff bedroom, three (3) bathrooms, an attached 2-car garage, family room, laundry room, office area, dining area, kitchen, and an outdoor covered seating area. LPA Kim toured inside and outside of the physical plant. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident room 1, resident room 2, resident room 3, resident room 4, resident room 5, and resident room 6. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 111.1 degrees F and 119.1 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water and emergency supplies are stored in the garage and in the staff room closet. All mandated inspection control posters were posted. The facility has smoke detectors and carbon monoxide detectors that were operable. The Certificate of Liability Insurance is effective from June 25, 2025, to June 25, 2026. The facility conducts Fire/Safety Drills quarterly and was last conducted on June 24, 2025. Four (4) fire extinguishers were mounted in the kitchen, garage, family room, and in the laundry room, and were last serviced on October 5, 2024. A working telephone (714-255-7917) and tablet device dedicated to the residents both remain available. First Aid Kit contained all the necessary elements. LPA Kim conducted an audit of six (6) residents (R1-R6) files, and six (6) staff (S1-S6) personnel files, and medication and medication administration records that all were complete and all in order. LPA conducted interviews for two (2) residents and two (2) staff. No deficiencies were being cited for today’s inspection visit. An exit interview was conducted, and a copy of this report was provided to Administrator Ines Otbo.the state’s words, verbatim · CDSS document, Aug 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with the Administrator and explained the reason for the visit. The Administrator, Ines Otbo Administrator's certificate expires on January 24, 2025. LPA and the Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the entry way of the facility. The facility is a single story home with 6 bedrooms, 3 bathrooms, living room, 2 dining rooms, office, family/activity room, kitchen, 2 car garage and a staff room. LPA observed the fireplace in the living room is screened. LPA toured the kitchen. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the knives are kept locked in a kitchen drawer. LPA observed the fire extinguisher in the kitchen is fully charged. LPA toured the resident rooms. LPA observed all resident rooms are clean and organized. All resident beds had the required linens. LPA observed all 3 bathrooms are clean and operational. How water measured 110.0 degrees Fahrenheit in the bathrooms. LPA toured the garage. The garage is used for storage and kept locked. LPA observed extra furniture, supplies and perishable food stored in the garage refrigerator. The family room has chairs for residents to sit and there is a TV mounted above the fireplace for residents to watch TV. The fireplace in the family is screened. There are reading materials and games in the family room for residents. LPA observed the medication is kept locked in cabinets in the family room. LPA toured the backyard. No bodies of water observed. LPA observed a covered patio in the backyard with chairs for the residents to sit outside. Both exit gate are operational. There is storage shed in the backyard that is used to store old furniture and wheelchairs. No obstacles or hazards observed inside or outside of the facility. LPA reviewed 2 staff files, no discrepancies observed. The 2 staff had the required 20 hours of annual training. LPA reviewed 6 resident files and medications, no discrepancies observed. Smoke detectors/carbon monoxide detectors tested operational. No deficiencies observed during the visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jun 19, 2024