Cleo's Home

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 01/15/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated representative, Mark Anthony Reyes, who was briefly interviewed at this time. Current census was 2 residents. It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there weren't any residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6041889740, for Cleo Brelin was observed to have an expiration date of 07/17/2026 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility kitchen cabinets, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the laundry room, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher that was located in the kitchen area was observed to have been annually inspected by the local fire extinguisher company, Touch Down Fire Inc, on 01/02/2026 and found to be in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted and noted on the LIC 859. A review of (2) facility resident records was conducted and noted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: Case Management - Other

Unannounced Annual visit made out to this facility on 01/15/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated representative, Mark Anthony Reyes, who was briefly interviewed at this time. This LPA requested that he go ahead and contact the facility designated Administrator, Cleo Brelin, to inform her that CCL was present at this time. The facility designated Administrator Cleo Brelin arrived shortly thereafter to this facility while this LPA was conducting this visit. Current census was 2 residents. It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there weren't any residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. Tour of this facility was conducted. The purpose of this case management visit was to review the former staff room that was recently fire cleared to return back into a resident room at this time. A brief tour of the resident room was conducted. There were no deficiencies observed or cited during today's case management visit at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 01/17/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Cleo Brelin. A brief interview was conducted with the facility designated Administrator at this time. Current census was 6 residents.. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 01/09/2025. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 01/09/2025: Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. A licensee shall ensure that infection control practices are maintained as follows: (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (B) Walls and window coverings in resident care areas shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary and when they are visibly contaminated or soiled. Plan of Correction clearance letter was printed and a copy was provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 17, 2025

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 01/09/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated representative, Mark Anthony Reyes, who was briefly interviewed at this time. Current census was 6 residents. It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there were (2) residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6041889740, for Cleo Brelin was observed to have an expiration date of 07/17/2026 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility kitchen cabinets, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the laundry room, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher that was located in the kitchen area was observed to have been annually inspected by the local fire extinguisher company, Butch Young Fire Group, on 01/02/2025 and found to be in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted on the LIC 859. A review of (6) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated representative at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 9, 2025

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 01/18/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Cleo Brelin. A brief interview was conducted with the facility designated Administrator at this time. Current census was 6 residents. It was learned that there weren't any residents under the care of hospice at this time. This facility does have a hospice waiver to be able to accept and retain up to (6) hospice residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there were (2) residents under the care of home health at this time. A tour of this facility was conducted. This Post Licensing visit was conducted in conjunction with the annual visit that was also completed on this day and time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 18, 2024

Type of visit: Required - 1 Year

Unannounced Post Licensing visit made out to this facility on 01/18/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Cleo Brelin. A brief interview was conducted with the facility designated Administrator at this time. Current census was 6 residents. It was learned that there weren't any residents under the care of hospice at this time. This facility does have a hospice waiver to be able to accept and retain up to (6) hospice residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there were (2) residents under the care of home health at this time. A tour of this facility was conducted. Tour of the facility was conducted. Living area, dining area, and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. Kitchen area was toured. Cabinets and drawers were reviewed. Knives and other sharp objects were observed to be locked and made inaccessible to the residents at this time. Food supply was reviewed to make sure that there was a sufficient amount of 2-day perishable and 7-day nonperishable quantities at all times. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures for handling, dispensing, and documentation of the resident medications was discussed with the facility designated Administrator. Dispensing log was also reviewed along with the Medication Administration Record. A tour of the resident bedrooms was conducted. Furnishings and furniture were observed to be sufficient and maintained in compliance at this time. A tour of the resident restrooms was conducted. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees at all times. Grab bars and non skid mats were observed to be present and in good repair at this time. A tour of laundry room was conducted. It was observed to be locked and made inaccessible to the residents at this time. Laundry detergent, bleach, and other cleaning agents were observed to be present as well. A tour of the garage area was conducted. Additional supplies and items were present for resident use. Linen closet, located in the facility hallway, was observed to be stocked with adequate towels, comforters, and sheets sufficient to meet the needs of the residents at this time. First aid kit was observed to be present and contained all of the necessary components at this time. Fire extinguishers (2) were observed to have been annually inspected on 01/08/2024 by the local fire extinguisher company, Butch Young Fire Equipment Company, and in compliance at this time. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gate, and all exits was conducted. It was observed that this facility has an exterior shed in the backyard area. A review of the shed was conducted and observed to be locked and made inaccessible to the residents at this time. A review of (6) facility resident files was conducted on the following LIC 858. A review of (3) facility staff files was conducted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There weren't any deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 18, 2024