Elite Manor Residential Care

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Robert Campbell conducted a case management visit to the facility for the purpose of follow up related to the case management visit on 5/05/2026. LPA Robert met with Emelinda Tuazon - Caregiver and explained the purpose of the visit and assisted LPA. William Lee/Administrator came to the facility later during the visit. LPA toured the facility, observed all medication and toxins locked in cabinets, no deficiencies at time of visit. LPA observed three structures used for storage at time of visit and documented on facility sketch LIC999. LPA cleared all plan of corrections at time of visit. An exit interview was conducted, and this report was discussed and provided to William Lee - Administrator.the state’s words, verbatim · CDSS document, Jul 21, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Robert Campbell conducted a case management visit to the facility for the purpose of issuing deficiencies related to Annual Inspection on 4/20/2026. LPA Robert met with Emelinda Tuazon - Caregiver and explained the purpose of the visit and assisted LPA. LPA spoke with William Lee - Administrator over the phone to explain the purpose of the visit. William Lee/Administrator came to the facility later during the visit. LPA toured the facility, observed, took pictures of the following physical environment Type A deficiencies, Resident#4 six (6) medications (photos taken of each medication) was unlocked in kitchen cabinet by oven the same place as the Annual on 4/20/2026, Resident#2 in Room #2 had three (3) medications unlocked sitting on the dresser (photos taken by LPA), three (3) toxins were unlocked in the kitchen under the sink cabinet (lock was broken), bathroom#1 two (2) toxins unlocked again (same as Annual on 4/20/2026) under the sink cabinet, bathroom#2 two (2) toxins (photos taken) unlocked in cabinet below sink. LPA observed three structures (LPA took photos) with staff personal belongings stored and beds not on the facility sketch and has no fire clearance. Facility will review deficiencies on the 809D document. Civil penalties will be assessed for repeated deficiencies. LPA during interviews of Administrator, two Staff, Resident#4 was in the living room in a gerry chair as a restraint with no exception from Community Care Licensing which is a personal rights violation.LPA will cite the facility with a Type A deficiency of violating the personal rights of Resident#4. Facility will review deficiency on the 809D document. An exit interview was conducted, and this report was discussed and provided to William Lee - Administrator.the state’s words, verbatim · CDSS document, May 5, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a)(b) · Plan of correction due date: May 6, 2026

The licensee shall ensure that disinfectants, cleaning solutions, poisonous substances....which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: LPA observed three (3) toxins were unlocked in the kitchen under the sink cabinet (lock was broken), bathroom#1 two (2) toxins unlocked again (same as Annual on 4/20/2026) under the sink cabinet, bathroom#2 two (2) toxins (photos taken) unlocked in cabinet below sink.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: LPA observed staff locking all toxins at time of visit. Licensee will have a contractor come out to the facility to install another lock in the kitchen cabinet under the sink by 5/15/2026. Licensee will have comprehensive training on locking toxins with material and sign in sheet by POC

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: May 6, 2026

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible....medication. This requirement is not met as evidenced by: LPA observed Resident#4 six (6) medications (photos taken of each medication) was unlocked in kitchen cabinet by oven the same place as the Annual on 4/20/2026, Resident#2 in Room #2 had three (3) medications unlocked sitting on the dresser (photos taken by LPA)the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: LPA observed staff lock medication at time of visit. Licensee will have a licensed professional train all staff on medication storage and administration by 5/19/2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: May 6, 2026

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(6)To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by: LPA during visit had interviews with the Administrator, two Staff, Resident#4 was in the living room in a gerry chair as a restraint with no exception.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: LPA observed resident#4 released from the gerry chair at time of visit. Licensee will have PCP write a order for use of gerry chair as restraint and submit a letter of exception to Licensing agency by 5/15/2026. All staff will have a training on personal rights with material and sign in sheet by 5/15/2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR87305(a)(b) · Plan of correction due date: Jun 2, 2026

(a) Prior to construction or alterations, all facilities shall obtain a building permit.(b) The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists.This requirement is not met as evidenced by: LPA observed three structures (LPA took photos) with staff personal belongings stored and beds not on the facility sketch and does not have approval from Licensingand has no fire clearance.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Licensee will have the city zoning department and city fire department visit facility to inspect added structures and submit clearance letters by POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Robert Campbell conducted an unannounced annual required visit. Upon entry, LPA was greeted by Emelinda Tuazon, caregiver, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff member and four (4) residents present. I Chen Lee/Administrator, arrived later during the visit. Facility Overview: The facility is a one-story home with six (6) bedrooms and four (4) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 118°F. Fire extinguisher located at dining room. LPA documented two (2) deficiencies on the 809D form of toxins and medication left unlocked in cabinets. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods.Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for four (4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four (4) resident files were reviewed and contained all the required documents. LPA reviewed two staff files without health screening documents. Type B deficiencies will be found on the 809D form. Health-Related Services/Incidental Medical Services: All resident medications were securely locked in hallway closet. LPA reviewed medications for four (4) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Personal & Incidental Funds: All residents are private pay no monies are handled by the facility. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on 3-19-2026, which met department requirements. All facility exits were clear of obstructions. All deficiencies cited during the visit are on 809D forms. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Apr 20, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that six (6) residents live at this facility. However, there were five (5) residents at the facility during the LPA’s visit. There were two (2) staff members present. The Administrator, William Lee was advised of the annual and came to conduct and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Six (6) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. The Administrator, William Lee Administrator’s certificate expiration date was 08/08/2025. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the designated laundry closet. There is a location for storing laundry soap, cleaning supplies and chemicals in the closet. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is one (1) secured fireplace at this facility. There are zero (0) pools at the facility. There is one (1) secured gate that has a self-latching lock located on the northeast side of the house. LPA observed emergency supplies and one (1) first aid kit. The last emergency fire drill was conducted on 02/02/2025. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed that they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed twelve dual (12) smoke detectors carbon monoxide detectors throughout the facility. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to Administrator, William Lee.the state’s words, verbatim · CDSS document, Feb 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that five (5) clients live at this facility. There are currently two (2) staff members present. The Administrator, William Lee conducted the tour. There is an Infection Control Plan on file. The facility is a one story, six bedroom, three bathroom home. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA reviewed client records. Client records contained current physician reports and all required documents. Personnel Records/Training/and Staffing- LPA reviewed employee records. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. All records were on file and up to date. Food Service- Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 118 degrees F. Laundry is done in the locked laundry room. (Continued on LIC809C) There is a locked cabinet for storing laundry soap and other chemicals, however LPA observed kitchen cleaning agents stored under the kitchen sink in an unlocked cabinet. Citation issued. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is a secured fireplace at this facility. There is not a pool at the facility. The facility performed the fire and emergency drills 2/15/2024. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were observed to be operable. Medications- are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA observed the following deficiency: --Medication was prepared and stored in pill containers for the evening distribution. Citation issued. An exit interview was conducted and a copy of this report was provided along with LIC 811, LIC 809D, and Appeal Rights to the Administrator..the state’s words, verbatim · CDSS document, Apr 29, 2024