Kelly's Place

Type of visit: Required - 1 Year

On 4/28/2026 at 10:00 am, Licensing Program Analyst (LPA) Toni Nwala made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Facility Manager, Nadine Garcia who was informed of the purpose of the visit. Licensee also arrived to the facility shortly after arrival. The facility has a fire clearance to serve six (6) non-ambulatory elderly residents. The facility also has an approved hospice waiver for four (4) and LPA was informed two (2)of the residents are currently receiving hospice services. LPA toured the facility with Facility Manager, Nadine Garcia and observed the facility is made up of a one story home with five (5) resident bedrooms, two (2) bathrooms, a kitchen, dining area, living room, laundry room, and attached garage. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. No bodies of water were observed on the premises. Indoor and outdoor pathways were free of obstruction. The facility had a two day supply of perishable foods and seven day supply of non-perishable foods. Medications and cleaning solutions/disinfectants are separately stored in different cabinets in the locked laundry room. Continue on 809-C LPA toured the garage and observed an additional food and emergency water. The facility has a room with additional incontinent supplies, blankets, linens, and pillows and emergency food. Licensee tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed a charged fire extinguisher mounted near the kitchen last serviced on 03/10/2026.Staff present has a criminal record clearance and a valid first aid/CPR certification. Resident files reviewed had updated physician's reports and personal rights. Licensee Kelly Hentzen informed LPA admission agreement was kept in a separate place due to confidentiality. LPA reviewed the facility's Emergency Drill Participation Time sheet noting the facility's last fire drill was conducted on 3/31/2026. LPA checked water temperature and reading is 113.5 F. Long Term Care Ombudsman's contact information, complaint procedures, and facility sketch are visibly posted in a hallway. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Hentzen.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Required - 1 Year

On 4/30/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Licensee, Kelly Hentzen who was informed of the purpose of the visit. The facility has a fire clearance to serve six (6) non-ambulatory elderly residents of which one (1) may be bedridden. The facility also has an approved hospice waiver for four (4) and LPA was informed none of the residents are currently receiving hospice services. LPA toured the facility with Licensee Hentzen and observed the facility is made up of a one-story home with five (5) resident bedrooms, two (2) bathrooms, a kitchen, dining area, living room, laundry room, and attached garage. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. No bodies of water were observed on the premises. Indoor and outdoor pathways were free of obstruction. The facility had a two-day supply of perishable foods and seven-day supply of non-perishable foods. Medications and cleaning solutions/disinfectants are separately stored in different cabinets in the locked laundry room. LPA toured the garage and observed an additional food and emergency water. The facility has a room with additional incontinent supplies, blankets, linens, and pillows and emergency food. Licensee tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed a charged fire extinguisher mounted near the kitchen last serviced on 3/17/2025. The facility's certificate of liability insurance expires on 5/1/2025. Staff present has a criminal record clearance and a valid first aid/CPR certification. Resident files reviewed had updated physician's reports and signed admission agreements. LPA reviewed the facility's Emergency Drill Participation Timesheet noting the facility's last fire drill was conducted on 3/22/2025. Long Term Care Ombudsman's contact information, complaint procedures, and facility sketch are visibly posted in a hallway. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Hentzen.the state’s words, verbatim · CDSS document, Apr 30, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Javina George conducted a visit for the purpose of confirming the recent changes to the facility. LPA received an updated facility sketch 10/13/23, as well as an updated approved fire clearance on 04/10/24. The facility had two additional bedrooms added, with the licensed capacity (6) remaining the same. LPA was greeted and granted entry by Administrator; Kelly Hentzen, who also has a current administrator certificate that expires on 7/14/25. At the time of the visit there were three (3) staff and five (5) residents present. The facility is licensed for a capacity of six (6), with one (1) of which may be bedridden. The facility has an approved hospice waiver for 4, of which there are three (3) residents currently on hospice. LPA conducted a tour of the interior and exterior of the single story home, and observed for the home to now consists of 6 bedrooms, 3 bathrooms, each bedroom was fully furnished. The home was clean, clutter and odor free. Inside the home bedroom # 1, 2, 3, 4, and 5 are approved for one Non-ambulatory resident. Bedroom # 6 (Master) is approved for one bedridden and one non-ambulatory resident; LPA observed for the facility food supply to meet the minimum requirements of having a 2 day supply of perishable and 7 day supply of non-perishable food items. LPA reviewed the storage and dispensing of medications and observed for them to be locked and inaccessible to residents No health and safety concerns were observed during today's visit. An exit interview was conducted, and a copy of this report was provided to Kelly Hentzen, Administrator.the state’s words, verbatim · CDSS document, Apr 15, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of conducting the annual inspection. LPA Colvin met with Administrator/Licensee Kelly Hentzen and informed her of the purpose of today's inspection. Below is a summary of what was observed: Infection Control: LPA Colvin observed that the facility has an updated Infection Control Plan on file and is demonstrating best practices in the facility to maintain a healthy environment for staff and residents. Such measures include soap and paper towels at hand washing stations, posted hand washing guides, and tight-fitting lids on trash cans. Physical Plant: LPA Colvin toured the facility and observed that there a sufficient bedrooms and bathrooms for both staff and residents. LPA Colvin observed the required furniture and linen to be present and in good condition in resident bedrooms. LPA Colvin measured the hot water in the bathroom faucets to be 122 degrees. Deficiency cited. Administrator/Licensee Kelly Hentzen informed LPA Colvin that she has been struggling with the hot water measuring too hot in the bathrooms but then not hot enough in the kitchen. Administrator/Licensee Kelly Hentzen stated that she plans on replacing the hot water heater, as other attempts to repair it have failed. The facility's carbon monoxide alarm and smoke detectors were recently tested for an updated fire clearance on 4/8/24 and were operational. Knives and other sharp objects are kept locked in a cabinet in the kitchen. Chemicals are locked in the laundry room. LPA Colvin observed sufficient supply of perishable and non-perishable food and utensils and dishes for the residents in care. Operational Requirements: LPA Colvin observed the facility to be operating within their licensed capacity of 6 non-ambulatory residents, one of which may be bedridden. Facility has a hospice waiver for 4 residents. Staffing & Staff Records: LPA Colvin confirmed that there are sufficient staff present to meet the needs of residents. LPA Colvin additionally confirmed that the facility has an Administrator with a current Administrator Certificate. LPA Colvin reviewed staff records and confirmed current CPR/First Aid Certification as well as training relevant to the facility and residents' needs. Resident Records: LPA Colvin reviewed the files for all 6 current residents to confirm that they have the required information present in their files, including Physician's Report, Admissions Agreement, and current Needs & Services Plan. Incidental Medical Services: LPA Colvin observed that resident medication is locked in a cabinet in the laundry room and is inaccessible to residents. LPA Colvin confirmed that the facility is not retaining any residents with prohibited health conditions. Planned Activities: LPA Colvin observed residents participating in various activities, such as puzzles, watching television, listening to music, and exercising. Emergency Disaster Preparedness: LPA Colvin confirmed that the facility has an Emergency Disaster Plan on file and are conducting quarterly disaster drills. An exit interview was conducted with Administrator/Licensee Kelly Hentzen and a copy of this report, LIC809D, LIC9098 Proof of Corrections, and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 15, 2024

Type of visit: Collateral

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to the facility to conduct a collateral visit for a complaint from Desert Cottage II, on the health, safety, and welfare of residents in care. RIV RO, Community Care Licensing received a complaint on 12/06/2023 in regards to Resident 1 (R1). LPA met with the Licensee, Kelly J Hentzen to inform her of the purpose of the visit and was granted entry. LPA toured the facility and observed all facility utilities to be on and operating without issues. Food supply is sufficient. There is no immediate concern for residents in care. LPA conducted an interview with R1 and request pertinent documents for the collateral visit. No deficiencies are being cited and no civil penalties per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted with Licensee, Kelly J Hentzen and a copy of this report is left with the her as evidence by her signature.the state’s words, verbatim · CDSS document, Dec 13, 2023