Kelly's Eastbury Villa

Type of visit: Annual/Random

On 8/28/26, Licensing Program Analyst (LPA) Kyle Wellington arrived unannounced to conduct an annual inspection. LPA was greeted and granted entry by Caregiver, Martha "Cece" Martinez, who was informed of the purpose of the visit. LPA met with Administrator (Admin) Garrett Welker, who also was informed of the purpose of the visit. The census at the facility is 6 residents. LPA received a resident and staff roster from Admin. LPA toured the inside and outside of the facility with Admin. LPA conducted an observation and record review for the inspection. Facility Overview: Facility is a one story house with six (6) resident bedrooms, one (1) resident bathroom, kitchen, dining room, family room, staff room, staff bathroom and attached garage. There are no pools, bodies of water or firearms at the facility. Facility has a fire clearance for six (6) non-ambulatory elderly adults of whom three (3) can be bedridden in rooms 2, 3, and 4. Hospice waiver was approved for six (6) residents. Infection Control: LPA observed hand sanitizers and soap dispensers throughout the facility. Cleaning equipment and supplies were kept in the locked garage and available for regular facility maintenance. LPA reviewed the facility’s infection control plan which met the department’s requirements. Physical Plant: LPA observed the inside and outside of the facility to be clean, safe and well kept. The family room and dining room furniture was in good repair. The residents' bedrooms and bathrooms were well maintained. The residents’ bedrooms contained the required bedding, lighting and furniture. Bathrooms had soap, paper towels, grab bars and non-slip floor in the shower. Extra linen was kept in resident's bedrooms and extra towels were kept in the resident's bathroom. Laundry equipment appeared to be in good working condition. Laundry supplies were kept in the locked garage. Two (2) fire extinguishers were charged and bought on 6/5/26. Facility has smoke and carbon monoxide detectors and a pull system fire alarm. The front yard and backyard was free of hazards and contained outdoor furniture and shaded area for residents. Kitchen/Food Service: LPA observed the kitchen to be clean, organized, and well maintained. The kitchen had the ability to prepare and store food in a safe and clean environment. Kitchen appliances appeared to be in good working condition. All sharp objects and cleaning supplies were kept in a locked cabinet under the kitchen sink inaccessible to residents. Facility has over a two day supply of perishable foods and over a seven day supply of non-perishable foods. Care and Supervision: LPA observed two (2) staff and five (5) residents at the facility. One (1) resident was away from the facility at the time of the visit. Facility has sufficient staff to supervise the residents. Administration: LPA observed facility sketch, facility license and administrator certificates posted near the front door. Long-term care ombudsman information and resident's bill of rights were also posted. Admin holds a current Administrator Certificate, CPR/First Aid Certificate and a Criminal Record Clearance. Resident & Staff Records: LPA reviewed the records of three (3) resident files and two (2) staff files. Staff present have CPR/First Aid Certificate, criminal record clearance and are associated with the facility. The files contained all the required documentation and paperwork. The staff and resident files were kept in a locked cabinet in the kitchen inaccessible to unauthorized individuals. Health Related Services/Incidental Medical Services: LPA observed clients' medications were centrally stored in locked storage carts in the kitchen inaccessible to residents. First aid kit was kept in locked storage carts in the kitchen and it contained all the required items. LPA reviewed three (3) residents' medications to the facility’s medication log to make sure all medication was accounted for and dispensed correctly. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan. It is current and up to date. Fire drills are done quarterly and was last completed on 8/5/26. Facility's property and liability insurance is current and expires on 8/16/27. All facility exits were clear of obstructions. No deficiencies were cited during this visit. An exit interview was conducted with the Administrator, Garrett Welker, and a copy of this report was given to Administrator, Garrett Welker.the state’s words, verbatim · CDSS document, Aug 28, 2026

Type of visit: Required - 1 Year

On 08/20/24 at 12:20pm Licensing Program Analyst (LPA), Javina George made an unannounced visit to the facility for the purpose of conducting a 1yr required annual inspection. LPA George met with House Manager Garrett Welker and explained the purpose of the visit. The facility has an approved hospice waiver for (6) with (2) resident's that are currently receiving hospice services. A facility file review was conducted on 08/1/24, LPA observed for the facility corporation governing body to be active. In addition LPA observed annual fees to be due on 08/12/24. During today's visit LPA observed for the balance to still not be paid. LPA inquired and was informed that the payment was submitted on or around 08/01/24. The facility was observed to have a sufficient food supply, as there was a 7 day supply of non-perishable and a 2 day supply of perishable food items.The facility was observed to be clean, clutter and odor free. The passageways are free from obstruction. There are no known guns or ammunition, or pools or bodies of water on the premises. The facility conducts emergency disaster drills on a quarterly basis, the last drill was conducted on 08/05/24. The facility has (2) fully charged fire extinguishers. The medications were observed to be locked in two separate storage containers, located inside of the kitchen. The sharps and chemicals were observed to locked and inaccessible to residents in care. The smoke and carbon monoxide detectors were tested and found to be operable. LPA conducted a file review of both staff and resident files. LPA observed for the resident files to have the required forms such as assessments, and admissions agreements. Regarding staff files, LPA observed for all staff present at the facility to have obtained proper fingerprint clearance and to be associated to the facility. The facility Administrator Maryline Siadto was observed to possess a valid administrator certificate, that expires on 10/29/24. While conducting a tour of the interior of the facility LPA observed for the facility to utilize video surveillance inside bedroom #6 Resident #4 (R4) room, LPA observed for there to be a signed consent from the responsible party, R4 is also in a private room. The monitor is stored inside the kitchen, and the purpose of the monitoring is for safety reasons associated with R4's behaviors Based on today's inspection no citations were issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report was provided to House Manager Garrett Welker.the state’s words, verbatim · CDSS document, Aug 20, 2024