Coloma Cottage

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Coloma Cottage. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, one of which may be bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 1 resident on hospice during today's visit. Maureen Salonga has an Administrator Certificate expiring on 10/24/2026. Caregiver Audi Baldonasa and Administrator Maureen Salonga arrived during the visit. LPA along with Caregiver Baldonasa toured the facility at 11:10 AM. LPA toured the physical plant, checked food service, and the first aid kit. Facility appears clean and sanitary upon entrance. The home consists of four resident bedrooms, one resident bathroom, one shared hall bathroom, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed four residents with half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.9 and 107 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Resident hygiene supplies are locked and inaccessible to residents. Common areas were clean and clear of hazards. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and exit gates are unlocked and self latching. CONT ON LIC 9099C DATED 03/03/2026 There is ample outdoor shaded seating for residents. LPA observed emergency food and water supply in the facility. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 02/16/2026. Facility provides activities in the form of games and exercise. LPA reviewed six resident files and four staff files. Resident files contained required documents including admission agreements, current physician reports, physician orders for bed rails and resident appraisals. Staff files reviewed contained required documentation of health screen/ TB, criminal record clearance and CPR/ first aid training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications appear to be administered per physician order. Licensee to submit an updated LIC 500 by close of business 03/06/2026. Based on the observations made during today's visit, NO deficiencies noted. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 3, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced Plan of Correction (POC) visit to the facility for the purpose of following up on citations issued on LIC form 809D during the annual required visit on 03/18/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. During today's visit, LPA observed medications are secured and inaccessible to residents in care. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87465(h)(5) pertaining to Incidental Medical and Dental has been cleared. During today's visit, LPA observed staff has discontinued pre-pouring medications. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87303(e)(2) pertaining to Water Temperature has been cleared. LPA tested water temperature to be between 110.8 and 113.5 degrees F. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87411(c) pertaining to Required Training has been cleared. Facility provided proof of training. Licensee has complied with the terms of the POC. Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations. Copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Coloma Cottage. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and met with Caregiver Anita Sacamay. Facility is licensed for 6 non-ambulatory residents, one of which may be bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 1 resident on hospice during today's visit. Maureen Salonga has an Administrator Certificate expiring on 10/24/2026. Caregiver Audi Baldonasa and Administrator Maureen Salonga arrived during the visit. LPA along with Caregiver Sacamay toured the facility at 7:52 AM. LPA toured the physical plant, checked food service, and the first aid kit. Facility appears clean and sanitary upon entrance. The home consists of four resident bedrooms, one resident bathroom, one shared hall bathroom, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed two residents with half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 122.3 and 125.2 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Resident hygiene supplies are locked and inaccessible to residents. Common areas were clean and clear of hazards. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 8:10 AM, LPA observed unsecured sharps and pre-poured medications in a kitchen cabinet (photos). Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and exit gates are unlocked and self latching. There is ample outdoor shaded seating for residents. LPA observed emergency food and water supply in the facility. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of CONT ON LIC 9099C DATED 03/18/2025 last fire drill conducted on 02/12/2025. Facility provides activities in the form of games and exercise. At 8:45 AM, LPA reviewed four resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed contained required documentation of health screen/ TB, criminal record clearance and CPR/ first aid training. One out of three staff do not have required staff training. At 9:15 AM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Mar 18, 2025

Type of visit: POC

Licensing Program Analysts (LPAs) Kimberly Lyman and Michael Tea made an unannounced Plan of Correction (POC) visit to the facility for the purpose of following up on citations issued on LIC form 809D during the annual required visit on 04/02/2024. LPAs were greeted and granted entry into the facility by Caregiver Anita Sacamay and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87705(f)(2) pertaining to Care of Persons with Dementia (Inaccessible items) has been cleared. During today's visit, LPA observed noted items on LIC 809 are secured and inaccessible to residents in care. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. During today's visit, facility has no odor. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87355(e)(2) pertaining to Criminal Record Association has been cleared. LPAs observed Staff 1 is associated to the facility. Licensee has complied with the terms of the POC. *Deficiency cited under Health and Safety Code 1565(c) pertaining to Emergency Drills has been cleared. Facility provided proof of emergency drill. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87412(c) pertaining to Personnel Records has NOT been cleared. LPA consulted with Licensee regarding training topics and reorganization of training proof and Licensee has agreed to resubmit training by close of business 04/25/2024. Licensee addressed all items noted on the advisory note issued 04/02/2024. Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations. Copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 18, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Lyman and Rose Ruppert conducted an unannounced visit to Coloma Cottage. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs were allowed entry into the home and met with Caregiver Anita Sacamay. Facility is licensed for 6 non-ambulatory residents, one of which may be bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 1 resident on hospice during today's visit. Maureen Salonga has an Administrator Certificate expiring on 10/24/2024. Caregiver Baldonasa arrived during the visit. LPAs along with Caregiver Audie Baldonasa toured the facility at 9:13 AM. LPAs toured the physical plant, checked food service, and the first aid kit. The home consists of four resident bedrooms, one resident bathroom, one shared hall bathroom, living room, dining room, and kitchen. Facility has a strong odor of urine upon entry. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed two residents with half bed rails. Resident bathrooms were checked. At 9:20 AM, LPAs observed unsecured cleaning supplies in the facility bathroom. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 112.6 and 115.5 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Resident hygiene supplies are locked and inaccessible to residents. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPAs toured the outside grounds and exit gates are unlocked and unsecured. LPAs observed emergency food and water supply in the facility. LPAs reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of CONT ON LIC 9099C DATED 04/02/2024 last fire drill conducted in 2022. Facility provides activities in the form of games and exercise. At 10:00 AM, LPAs reviewed five resident files and four staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed did not contain required documentation of annual training. Staff 1 is not associated to the facility. At 11:00 AM, LPAs reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly by staff. Medications are being administered per physician order. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Apr 2, 2024

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Apr 3, 2024

The following shall be stored inaccessible to residents with dementia: .. and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not being met as evidenced by: Based on observation, Licensee failed to ensure cleaning supplies were inaccessible to residents in care. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 2, 2024

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Apr 3, 2024

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed faciilty: Request a transfer of a criminal record clearance... This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure Staff 1 was associated to the facility. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 2, 2024

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Apr 3, 2024

A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter... This requirement is not met as evidenced by: Based on record review, Licensee failed to ensure emergency drills are conducted. Last documented drill was in 2022. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 2, 2024

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Apr 16, 2024

Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure all staff have required annual training. This poses a potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Apr 2, 2024

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Apr 16, 2024

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not being met as evidenced by: Based on observation, Licensee failed to ensure facility is clean and sanitary. There is a strong odor of urine in the facility. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 2, 2024

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.