Chantilly Lace Manor II

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Magda Malcore and Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs were granted entry to the facility and met with Licensee Teresa Baddeley. At the time of the visit there was one (1) staff, The Licensee, and three (3) residents present. Physical Plant: Indoor and outdoor passageways are free of obstructions. The facility is maintained at a comfortable temperature of 70 degrees Fahrenheit. LPAs inspected resident bedrooms; they are equipped with the required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom to be at 105 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as Community Care Licensing complaint poster, Ombudsman poster, labor law, facility license, and facility sketch were posted in a common area. Cleaning supplies, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a medication room with the resident’s medications locked. LPAs observed first aid kit and manual. Yards/Outside: One shaded patio, one self-latching gate and an attached two (2) car garage was observed. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. LPAs observed that the facility does not have enough emergency food and water for 72 hour emergency. Citation issued. Record Review: LPAs reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPAs observed resident files were complete. LPAs reviewed three (3) residents medications. LPAs found that R1 and R2 medication records were not accurately maintained by staff. Deficiency issued. LPAs reviewed three (3) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. LPAs observed staff#1 (S1) and staff#3 (S3) did not have a health screening with tuberculosis results on file. Staff#2 (S2) did not have a health screening on file. S3 did not have First Aid/CPR certification on file. Deficiency issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations and per Health and Safety Codes (HSC) An exit interview was conducted, and this report LIC809, LIC809C, LIC809D forms, and Appeal Rights were discussed and provided to Licensee.the state’s words, verbatim · CDSS document, Feb 27, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Magda Malcore and Eldin Serrano conducted an unannounced visit to the facility. LPAs met with staff, Heilala Poloa, explained the purpose of the visit and was granted entry into the facility. During today's visit, LPAs requested from staff Poloa, resident registry, resident files which contain resident admission's agreement and physician's reports pertaining to complaint investigation 56-AS-20251008092142. Staff stated that that they did not have access to resident files that contain that information. A deficiency is being cited in accordance with Title 22 of the California Code of regulations. An exit interview was conducted where this report was discussed and a copy provided with appeal rights to Staff Poloa at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(d) · Plan of correction due date: Oct 29, 2025

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours...this requirement is not met as evidence by: The Licensee did not comply with the section cited above by LPAs not having access to residents files which contain admissions agreement and physician's reports and resident registry during visit. Staff stated they did not have access to the files; which is a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: The Licensee/Administrator shall read and submit a statement of understanding of regulation cited to the licensing agency by POC due date.

Allegation investigated: Facility staff restrain a resident in care

Licensing Program Analysts (LPAs) Magda Malcore and Eldin Serrano conducted a unannounced complaint visit to the facility. LPAs were granted entry, met with Administrator, Teresa Baddeley, and informed the purpose of the visit. The investigation consisted of document review, observations, and interviews with pertinent parties. Regarding the allegation, facility staff restrain a resident in care, LPAs observed resident #1 (R1) wearing a gait lap belt at the facility. Review of R1's file record reveals the facility has a current physician's order for the use of gait belt. Based on the department's investigation, the allegation above is Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy provided with appeal rights to Administrator Baddeley at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 25, 2025 · control 56-AS-20250822143428

Type of visit: POC

Licensing Program Analysts (LPAs) Magda Malcore and Eldin Serrano conducted an unannounced Plan of Correction (POC) visit to the facility. LPAs met with Heilala Paola, Caregiver,were granted entry and explained the purpose of the visit. Licensee Teresa Baddeley arrived to the facility shortly after and explained the purpose of the visit. On 02/12/25 deficiencies were cited during a facility inspection and correction plans were due on 03/10/25. As of today’s visit, the following deficiencies have not been cleared: · a statement of understanding of regulation cited [87465(d)(3)] was not provided to the LPAs. Licensee Baddeley stated that once her appeal is denied she will provide the statement of understanding. · a copy of resident #1 (R1) signed admission’s agreement was not provided to the LPAs during today's visit. The Licensee stated she will have the family signed the documentation and submit a picture of the signed document the LPA. · LPAs observed that facility supplies and equipment were still stored in resident’s designated private bathroom closet. · LPAs observed that surveillance cameras were still mounted in all residents’ bedrooms. Civil penalties of $3600 were accessed today for failure to correct deficiencies due on 3/10/2025 and civil penalties will continue to accrue $100 per day per violation until proof of correction has been received. An exit interview was conducted with the licensee. Copies of reports LIC809 & LIC421FC were provided with appeal rights to Licensee Baddeley at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) made an unannounced visit to the facility to conduct a required comprehensive annual inspection. LPA met with Licensee, Teresa Baddeley and caregiver, Carmen Enriquez. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (6), and a current census of (6). LPA conducted a general inspection of facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor and outdoor space for resident activities. The facility is maintained at a comfortable temperature of 72 degrees F. Resident (5) bedrooms were furnished with beds, bedlinen, night stands, chairs, and lighting. LPA observed cameras mounted on the wall of each resident's bedroom. Resident (3) bathrooms were maintained clean and sanitary. The hot water temperatures in the bathrooms measured at 106 degrees F. LPA observed resident's private bathroom had a closet which was utilized to store facility's personal hygiene/incontinence products for all residents in care. The facility is equipped with smoke detectors/carbon monoxide alarms, laundry equipment, cover fireplaces and telephone service. Posters such as personal rights, the Community Care Licensing complaint poster, Ombudsman poster, facility license and the disaster plan were posted. Cleaning supplies and sharps were kept inaccessible to residents in care. Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply is sufficient for number of residents in care. Medications/Health related services: Medications were centrally stored in a locked cabinet. LPA asked staff #4 (S4) to assist with providing resident medication administration logs. S4 stated that the facility does not maintain record/log of when medication is administered to residents. LPA asked staff for current medication list/record, S4 stated they were not familiar with how the facility manages the medication list since they are fill-in staff for that shift. **continued on LIC809-C** Record Review: LPA reviewed (3) resident files for admission agreements, updated physician reports, appraisals, and needs and services plans. LPA observed missing authorized persons signatures on several pages of Resident #1 (R1's) admissions agreement. LPA reviewed (3) staff files for employment history, first Aid/CPR certifications, criminal record clearances, training, and health screenings. LPA observed staff#1 (S1), staff#2 (S2), and staff#3 (S3) did not have a complete health/physical screening for review. Deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where reports (LIC809/LIC809-C/LIC809-D/ LIC9102) were discussed. Copies provided with appeal rights to Caregiver Enriquez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 12, 2025

Allegation investigated: Facility staff did not seek timely medical attention for a resident.

Licensing Program Analysts (LPAs) Anna Bueno and Michelle Echeverria conducted an unannounced visit to this facility for the purpose of initiating the investigation of and delivering findings for the above allegation. LPAs met with licensee Teresa Baddeley who was advised of the purpose of visit. The investigation consisted of records review and interviews with relevant parties. It is alleged that Resident 1 (R1) was not provided timely medical attention by facility staff. LPA Bueno conducted interviews that revealed that R1's change of condition was observed by Witness 1 (W1) who reported the change to their agency and to facility staff. Interviews further revealed R1 was not seen by any medical personnel from the outside agency providing R1 with services. Records reviewed also revealed that R1 was receiving services from an outside agency when their condition was observed by W1 and that R1 was taken to the local hospital for treatment on the same day R1's condition was observed. This allegation is therefore unsubstantiated. A finding of UNSUBSTANTIATED means although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted with Licensee and a copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 24, 2024 · control 56-AS-20240117121300

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87265(d)(3) · Plan of correction due date: Feb 2, 2024

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement was not met as evidenced by: LPAs inspected resident medications and centralized record and found three medications not listed on the centralized record. Two of three medications appeared to have been administered, which poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Jan 24, 2024

Plan of correction: Licensee shall conduct an audit of all resident medications and complete a completed list of all resident medications. Licensee shall submit proof of correction to the Department no later than end of POC date.

Type of visit: Required - 1 Year

On 1/24/24, Licensing Program Analysts (LPAs) Michelle Echeverria and Anna Bueno arrived unannounced to conduct the required annual visit to the facility. LPAs met with Licensee, Teresa Baddeley and introduced self and stated purpose of the visit. LPAs were informed that there are currently 6 residents in care. The facility has 5 bedrooms, 3 bathrooms, 2 kitchens, dining area, living room, family room, sitting room, office, laundry/medication room, attached garage and backyard. LPAs completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees fahrenheit. LPAs inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPAs inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 109 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, charged fire extinguisher and first aid kit. Posters such as; the personal rights, emergency disaster plan, CCL complaint poster and ombudsman were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked and inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed locked and inaccessible to residents. There is no swimming pool, firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for residents in care. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, side gate with self-latching handle on the left and right side of the house that leads into the backyard. Record Review: LPAs reviewed staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPAs reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPAs reviewed medication and observed altered labels, expired medication and medication not logged. Deficiencies issued. LPAs observed the Emergency Disaster Plan and Infection Control Plan incomplete. Deficiencies issued. Deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and appeal rights were discussed and copies were provided to Licensee, Teresa Baddeley.the state’s words, verbatim · CDSS document, Jan 24, 2024