The Carlisle-Ivy Signature Living

Type of visit: Required - 1 Year

On 8/17/2026, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Executive Director Alex Tayebi and explained the purpose of the visit. LPA toured the facility. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected.. No accessible bodies of water or fire safety hazards observed. While touring the facility it was observed that the temperature was at 70 - 72 deg F. All personal belongings of residents are intact. Facility has sprinkler system. All fire extinguishers have been checked and current. Smoke and carbon monoxide detectors and fire safety systems are interconnected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen, sufficient for residents in care. Emergency drills are done monthly. Six resident records and six staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No deficiencies are cited at this time. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Aug 17, 2026

Type of visit: Case Management - Incident

On 11/19/2025, Licensing Program Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to an incident in which a resident, R1 was given multiple doses of a medication. LPA Calandra was greeted by Alex Tayebi, Executive Director and explained the purpose of the visit. On 11/17/2025, the Department received an incident report describing a medication error incident that occurred on 11/15/2025. Based on the report, R1 received extra doses of a medication over a two day period. During the visit on 11/19/2025, LPA learned that R1 was recently discharged from the hospital for another infliction and was provided the medication at the hospital in the morning prior to discharge. Based on record review, hospital discharge paperwork does not reflect the change in medication administration post discharge. Based on interview, R1 is feeling well and no side effects have been reported. LPA received the following documents while at the facility: Pharmacy medication orders, hospital discharge documentation, and incident reports. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy provided via email.the state’s words, verbatim · CDSS document, Nov 19, 2025

Type of visit: Case Management - Other

On October 9, 2025, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced case management visit to follow up on an exception request related to MRSA for Resident R1, which was submitted to the Community Care Licensing Division (CCLD) on September 19, 2025. LPA met with the Health Services Director, John Paul R Franco, Regional Health Service Director, Ana Wilson, arrived later during the visit, and explained the purpose of the visit. Resident R1 tested positive for MRSA on September 19, 2025. During the visit, LPA interviewed staff and collected documentation. LPA requested the following documentation: A statement from a medical professional confirming R1’s ability to self-administer medication. medical records, including documentation of R1’s MRSA diagnosis A signed and updated Individualized Service Plan (ISP), and An updated physician’s report. The report was reviewed with the Regional Health Service Director, and a copy was provided.the state’s words, verbatim · CDSS document, Oct 9, 2025

Type of visit: Case Management - Other

On 10/3/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to a Change in Management request. LPA Calandra was greeted by Alan Fox, Regional Operations Specialist and Laura Valdez, Business Office Director and explained the purpose of the visit. LPA Calandra requested the following documents: -Updated LIC 200 with new administrator name. -LIC 501-Personnel Report -LIC 503-Health Screening Report -Copy of photo ID -Copy of current Administrator Certificate -Copy of First Aid/CPR Certificate -Fingerprint clearance. -Updated LIC 610E Emergency Disaster Plan -Updated LIC 9282 Infection Control Plan -If you signed the hospice waiver request, please submit new request for new administrator. -Board Resolution Letter(Letter appointing the new administrator from the Board) No deficiencies were cited during today's visit. An exit interview was conducted. This report was emailed to the facility representative.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Required - 1 Year

On 8/21/2025, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Regional Operations Specialist (ROS), Alan Fox and explained the purpose of the visit. LPA toured the facility and a random sample of resident rooms, common areas, and kitchen area. LPA observed some residents were at the wellness center. While touring the facility it was observed that the temperature was at 70 deg F. Hot water was also tested in the resident rooms and the temperature was at 105 deg F. All personal belongings of residents are intact. Facility has sprinkler system. All fire extinguishers have been checked and current. Smoke and carbon monoxide detectors and fire safety systems are interconnected. Resident bedrooms and bathrooms were observed to be in good repair equipped with grab bars and non-skid floors. There is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Emergency drills are done every month. Six resident records and six staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. Medications are audited quarterly. LPA recieved the Certificate of Liability Insurance. No deficiencies are cited at this time. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Required - 1 Year

On 8/29/2024, Licensing Program Analysts (LPA's) Tobola & Jian conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Executive Director, Jeffrey Brenner. The facility currently provides care for 93 residents, 1 of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each resident floor and kitchen were found to be last charged on November 2023. Smoke and carbon monoxide detectors and fire safety systems are interconnected. Fire Safety Inspections completed on March 1, 2024 indicating all fire safety devices and systems to be in order. Water at faucets accessible to residents measured between 105.0 and 120.0 degrees F which is within regulation. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished twice per week and stored properly. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets throughout each floor, and housekeeping/maintenance rooms all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Residents that were awake during the inspection were observed interacting with staff, fellow residents and visitors in the common areas, or in their bedrooms resting. The facility encourages regular family visits and utilizes a wide variety of activities with LPA observing staff engaging continuously with residents, offering activities based on individualized preferences and abilities. LPA found that staff and resident engagement is well practiced with activity calendars developed on a monthly basis. Residents were observed to have a positive and personable relationship with staff. Continued onto LIC809-C LPA conducted a sample file review for 9 residents and found all items to be on file. LPA's found that residents Needs & Service Plans are up to date, however the Executive Director is in the process of acquiring updated signatures from residents and family. Technical Violation issued. Upon a spot check of nine (9) staff files, LPA found that caregiver staff have current first aid and annual training on file. Lastly, A spot check of medications was conducted and found that all medication counts and records are in order. Jeffrey Brenner's Administrator Certificate 6068069740 is currently active through 1/17/2026. LPA requested the following documents be sent to CCL by COB 9/12/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Liability Insurance No deficiencies cited during the visit.the state’s words, verbatim · CDSS document, Aug 29, 2024

Type of visit: Case Management - Other

On May 31, 2024 at 2:08 PM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a case management visit regarding an item that had been previously reported as missing in February 2024. LPA Calandra was greeted by Jeffrey Brenner, Executive Director and explained the purpose of the visit. LPA Calandra reviewed 1 resident record and obtained a copy of R1's, Statement of property and valuables. No deficiencies were cited during today's visit. This report was reviewed with Jeffrey Brenner, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, May 31, 2024