Miles Place of Fountain Valley 2

Type of visit: Required - 1 Year

On March 12, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Required-1 year annual inspection. LPA Bentley was greeted and granted entry by staff after stating gthe purpose of the visit. Administrator (AD) Mark Cruz arrived shortly after and was present to assist with the visit. Mark Cruz has an Administrator certificate with an expiration date of December 2, 2026. The facility is licensed for age range 60 and over, with the for capacity of six (6) Non-Ambulatory residents, and has a hospice waiver for six (6) residents. There are currently four (4) residents present during today’s visit. The facility is a two-story house and the second story consists of: 4 bedrooms, and 3 bathrooms which are utilized for caregivers. The first floor consists of: 4 resident bedrooms; of which 2 bedrooms are shared bedrooms, 2 are private bedrooms, 3 bathrooms, living room, dining area, and kitchen. LPA Bentley toured the interior and exterior of facility with staff, and the following was observed: There were no bodies of water on the premises, all rooms were inspected, beds and bedding supplies were available, lighting was provided in all rooms, and storage for the residents’ personal belongings were observed in residents’ closets. Additional bed linens, comforters, and bath towels were available during the visit. The water temperature in 3 of 3 resident bathrooms were measured to be between 113.7 and 114.3 degrees Fahrenheit. Grab bars and non-slip mats were observed in all resident bathrooms. The kitchen was clean and organized. All knives and sharp objects were locked in a drawer near the stove. A two-day supply of perishable food items and seven-day supply of nonperishable food items was observed. CONTINUE TO LIC-809C PAGE.... LPA observed two fire extinguishers mounted and charged in garage downstairs and hallway upstairs that were last serviced on March 5, 2025. There is also an additional fire extinguisher mounted and charged in downstairs hallway area, which was last serviced on August 13, 2025. Carbon monoxide detector and smoke alarms were tested and all operational. The attached 2-car garage was observed clean and walkways were free of clutter and debris. A washer and dryer was found in working condition. LPA Bentley observed an adequate amount of emergency food and water supply. The backyard was clean and free of clutter and debris. The exit gate on the exterior of the home was self-latching and in operating condition. LPA conducted a review of four residents service files (R1-R4), three (3) staff personnel files (S1-S3), and a review of the medication and Medication Administration Record (MAR), which was conducted and found to be within Title 22 California Code of Regulations. LPA Bentley conducted interviews residents and staff during the visit. The facility has liability insurance on file effective May 15, 2025 through May 15, 2026. Based on the observations made during today’s visit, no deficiencies are being cited. An exit interview was conducted with Administrator Mark Cruz, and a copy of this report provided at exit.the state’s words, verbatim · CDSS document, Mar 12, 2026

Type of visit: Required - 1 Year

On March 10, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced visit for the purpose of conducting an Annual Required-1 year inspection visit. LPA Bentley was greeted and granted entry by Caregiver (CG) Jovalyn Galang. Administrator (AD) Mark Cruz arrived shortly after and discussed purpose of the visit with LPA Bentley. AD Mark Cruz has an Administrator certificate pending renewal with a received date of November 22, 2024. The facility is licensed for age range 60 and over, approved for capacity of six (6) Non-Ambulatory residents, and has a hospice waiver for three (3) residents. There are currently six (6) residents present during today’s visit. The facility is a two-story house of which second story consists of: 4 bedrooms, and 3 bathrooms which are utilized for caregivers. The first floor consists of: 4 resident bedrooms; of which 2 bedrooms are shared bedrooms and 2 are private bedrooms, 3 bathrooms for staff and residents, living room, dining area, and kitchen. There is a sun room in the back of the facility next to dining area used as an activity room and for family visitations. LPA Bentley toured the interior and exterior of facility with AD Cruz. and the following was observed: There were no bodies of water on the premises, all rooms were inspected, beds and bedding supplies were available, lighting was provided in all rooms, and storage for the residents’ personal belongings were observed in residents’ closets. Additional bed linens, comforters, and bath towels were available during the visit. The water temperature in 3 of 3 resident bathrooms were measured to be between 101.2 and 129.5 degrees Fahrenheit. This poses an immediate risk to residents in care. (SEE LIC 809-D) Grab bars and non-slip mats were observed in all resident bathrooms. The kitchen was clean and organized. All knives and sharp objects were locked in a drawer near the stove. A two-day supply of perishable food items and seven-day supply of nonperishable food items was observed. CONTINUE TO LIC-C PAGE.... LPA observed three fire extinguishers mounted and charged in garage, kitchen, and hallway area, which were last serviced on March 5, 2025. LPA observed and tested carbon monoxide and smoke alarms which all operational. A record review reveals fire drills are being conducted quarterly with the last drill on January 25, 2025. The attached 2-car garage was observed clean and walkways were free of clutter and debris. A washer and dryer were found in working condition. LPA Bentley observed an adequate amount of emergency food and water supply. The backyard was clean and free of clutter and debris. The exit gate on the exterior of the home was self-closing and self-latching, and in operating condition. LPA conducted a review of six residents (R1-R6) service files and five (5) staff (S1-S5) personnel files revealed to be complete. Facility has liability insurance on file effective May 15, 2024 through May 15, 2025. A review of the Medication Records Administration (MAR) was conducted and found to be within Title 22 California Code of Regulations. LPA Bentley interacted with and interviewed 6 of 6 residents during facility tour. Based on the observations made during today’s visit; the facility is being cited per Title 22 Division 6 of the California Code of Regulations This report was read and reviewed with (AD) Mark Cruz, and a copy of this report and Appeal Rights were provided at exit.the state’s words, verbatim · CDSS document, Mar 10, 2025

Type of visit: Required - 1 Year

On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting an Annual Required-1 year inspection visit. LPA was greeted by Caregiver 1. Administrator (AD) Mark Cruz arrived shortly after and discussed purpose of the visit. AD Mark Cruz has an Administrator certificate with expiration date of 12/2/2024. The facility is a two-story house of which second story consists of: 4 bedrooms, and 3 bathrooms which is utilized for caregivers and Administrator headquarters. The first floor consists of: 4 resident bedrooms; of which 2 bedrooms are shared bedrooms and 2 are private bedrooms, 3 bathrooms for staff and residents, living room, dining area, and kitchen. There is a sun-room in the back of the facility next to dining area used as an activity room and for family visitations. There is an attached 2 car garage with an operational washer and dryer. The backyard has a shaded concrete area for resident and visitor enjoyment. The exit gates on the exterior of the home are locked from the outside have self-closing and self-latching mechanisms in operating condition. The facility is licensed for age range 60 and over, approved for capacity of 6 (six) Non-Ambulatory residents, and has a hospice waiver for (6) six residents. There are currently (4) four residents currently receiving hospice care services. LPA along with CG1 toured the interior and exterior of facility. LPA observed kitchen for proper sanitation and cleanliness. LPA observed Sharp objects locked and secured in cabinet in kitchen area, and observed toxin substances to be locked and inaccessible to residents in care in locked and secured closet in garage area. The food was observed to meet the minimum requirement of two days perishable and seven days nonperishable food supply for residents in care. CONTINUED ON LIC 809-C PAGE... CONTINUED...Six of six resident bedrooms were observed to have required furnishings including but not limited to: lamp, bed, mattress, night stand and clean linen. LPA Quiroz interacted and interviewed 3 of 6 residents during facility tour. LPA Quiroz not able to qualify and interview 3 of 6 residents in care. The water temperature in 3 of 3 resident bathrooms were measured to be between 114.7-116.6 degrees Fahrenheit. The Grab bars and non-slip mats were observed in resident bathrooms. Room temperature inside the facility was recorded to be 74 degrees F. During today’s visit, LPA Quiroz observed temperature gage box to be locked and secured. (SEE LIC 9102-TV) The outside grounds were inspected during facility tour, and no bodies of water were observed. No pool available at this facility. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA observed three fire extinguishers mounted and charged in garage and hallway area, which were last serviced on 3/05/2024. LPA observed and tested functional and operational carbon monoxide and smoke alarms. (AD) Mark Cruz reports fire drills are conducted quarterly with staff and residents. Last facility fire drill was conducted on March 22,2024. CG1 reported offering the following indoor and outdoor activities at the facility according to weather conditions: "walks, painting, ball and arm range of motion exercises." LPA Quiroz reviewed whether the facility is operating within capacity limitations and reviewed repeated violations, no repeated violations assessed. During today's visit, LPAs reviewed six of six resident records and four of four personnel files. Resident and personnel files were found to be within Title 22 California Code of Regulations. At 3:23pm, LPA Quiroz reviewed centrally stored medications for 6 of 6 residents. During centrally stored medication review, LPA Quiroz observed 4 of 6 resident’s centrally stored Comfort KIT medications consisting of: Acetaminophen, Morphine, Lorazepam, Bisacodyl, Hyoscyamine, Ondansetron and Albuterol in refrigerator in kitchen which is unlocked and unsecured. This poses an immediate risk to residents in care. (SEE LIC 809-D) During today's visit, LPA Quiroz provided Consultation on Title 22, COVID-19 Mitigation and Infection control throughout today's visit. Based on the observations made during today’s visit; the facility is being cited per Title 22 Division 6 of the California Code of Regulations. This report was read and reviewed with (AD) Mark Cruz, and a copy of this report, LIC 858, LIC 859, LIC 809-D, LI 9102-TV and Appeal Rights were provided at exit.the state’s words, verbatim · CDSS document, Apr 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Apr 19, 2024

87705(f)(2):Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia:(1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).(2) Over-the-counter medication... CONT This requirement is not met as evidence by: At 3:23pm, LPA Quiroz reviewed centrally stored medications for 6 of 6 residents. During centrally stored medication review, LPA Quiroz observed 4 of 6 resident’s centrally stored Comfort KIT medications consisting of: CONTINUE...the state’s words, verbatim · CDSS document, Apr 15, 2024

Plan of correction: AD Mark Cruz agreed to read and understand CCR 87705 and provide inservice training to all staff identified on LIC 500 by POC Due date of 4/19/2024. 4 of 4 comfort kits were relocated to locked and secured refrigerator in garage area during today's visit. Acetaminophen, Morphine, Lorazepam, Bisacodyl, Hyoscyamine, Ondansetron and Albuterol in refrigerator in kitchen are which is unlocked and unsecured. This poses an immediate risk to residents in care.