Cypress Ridge Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 11:25am to conducted a 1 year Annual visit to the facility above. LPA met with Administrator Rachelle Tellez and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Infection Control Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. The facility staff have taken annual Infection control and PPE training. Physical Plant & Environment Safety: The facility is a 6 bedroom and 6 bathroom home currently occupying 6 residents and 7 staff, including 3 administrators. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. Laundry room has working washer and dryer. Operational Requirements: The Facility is operating in compliance with fire clearance. Capacity is 6 with 1 non-ambulatory and 5 bedridden with a hospice waiver for 3. The facility has current liability insurance on file. The facility has dual hard wired smoke and carbon monoxide detectors with sprinkler system. Staffing: The facility currently employs 7 staff and 3 Administrators. Staff records are kept confidential. The 5 files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and Criminal Record clearance or exemption. Administrator Certificate for Roxandra Whitestine Administrator expires 08/30/2027. Continued 809-C Personnel Records & Training: The facility keeps confidential files for each staff member. Staff had 20 plus hours of annual training completed for all subjects/topics/hours for 2025-2026. Newly hired staff have 40 plus hours of initial training for 2025 & 2026. Training records are up to date and on file. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physician’s reports Pre-appraisals, Appraisals Needs and Services Plan, and Emergency and ID forms, all forms were legible and records are kept confidential. Resident Rights Information: All require postings were posted in common areas of facility. Personal rights, Rights to Resident Council, Theft and Loss policy, Non-discrimination notice in addition to a CCL Complaint poster, PIN, License, Hospice Waiver, Emergency Disaster plan and LTCO poster. Planned Activities: The facility offers activities to all residents in care. Activities include arts and crafts, books, magazines, newspapers, TV watching, daily walks, group discussions and communications, and puzzles. The facility has sufficient space to allow for activities indoors and outdoors. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available in the pantry and garage. Incidental Medical & Dental: Facility provides transportation to medical and dental appointments when needed. The medications were reviewed for all 6 residents with the Centrally Stored Medication and Destruct Records (CSMDR) and the Medication Administration Record (MAR). LPA inspected 6 residents medications, all medications were in the original containers, prescription labels were not altered, and no medications were expired. Doctors orders were present and dispensing instructions were followed. Disaster Preparedness: The current emergency disaster forms were posted. The facility provided quarterly disaster drills for 2025-2026. The fire extinguishers were charged and last inspected on 05/20/2026. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked separately in cupboards. The facility does not currently have hospice or home health residents in care.The facility does not have residents currently using oxygen. Facility is completely fenced with self closing and self latching gates. The facility does not have delayed egress. LPA interviewed 2 staff and residents. Exit interview conducted and copy of report printed for Backup Administrator.the state’s words, verbatim · CDSS document, Jun 9, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) De Leon arrived at 2:45pm to conducted a Case Management Annual Continuation visit to the facility above. LPA met with Administrator Roxandra Whitestine explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Infection Control Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has trash bins with lids/covers. The facility has a 30 day supply of PPE. The facility staff have taken annual Infection control and PPE training. Physical Plant & Environment Safety: The facility is a 6 bedroom and 6 bathroom home currently occupying 5 residents and 7 staff, including 3 administrators. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. Laundry room has working washer and dryer. Operational Requirements: The Facility is operating in compliance with fire clearance. Capacity is 6 with 1 non-ambulatory and 5 bedridden with a hospice waiver for 3. The facility has current liability insurance on file. The facility has dual hard wired smoke and carbon monoxide detectors. Continued 809-C Resident Rights Information: All require postings were posted in common areas of facility. Personal rights, Rights to Resident Council, Theft and Loss policy, Non-discrimination notice in addition to a CCL Complaint poster, PIN, License, Hospice Waiver, Emergency Disaster plan and LTCO poster. Planned Activities: The facility offers activities to all residents in care. Activities include arts and crafts, books, magazines, newspapers, TV watching, daily walks, group discussions and communications, and puzzles. The facility has sufficient space to allow for activities indoors and outdoors. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available in the pantry and garage. Incidental Medical & Dental: Facility provides transportation to medical and dental appointments when needed. The medications records were reviewed for all 5 residents with the Centrally Stored Medication and Destruct Records (CSMDR). LPA inspected 5 residents medications, all medications were in the original containers, prescription labels were not altered, and no medications were expired. Doctors orders were present and dispensing instructions were followed. Disaster Preparedness: The current emergency disaster forms were posted. The facility provided quarterly disaster drills for 2025. The fire extinguishers were charged and dated 03/12/2025. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked separately in cupboards. The facility does have hospice and home health visits to the facility for residents in care. Facility is completely fenced with self closing and self latching gates. The facility does not have delayed egress. The facility does have 1 residents currently using oxygen and signs are posted. LPA interviewed 1 staff, all residents were sleeping. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Oct 15, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon conducted a 1 year Annual visit. LPA met with Jessica Bailey back up Administrator and explained the purpose of the visit. LPA De Leon met Administrator at Centralized location for the Rose Group to conduct the file review for the residents and staff. Staffing: The facility currently employs 10 staff and 3 Administrators. Staff records are kept confidential. The 5 files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and Criminal Record statements. Administrator Certificate for Roxandra Whitestine Administrator of record expires 08/30/2025. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff had 20 hours of annual training completed for all subjects/topics and hours for 2024-2025. Newly hired staff have 40 plus hours of initial training for 2025. Training records are up to date. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physician’s reports Pre-appraisals, Appraisals Needs and Services Plan, and Emergency and ID forms, all forms were legible and records are kept confidential. LPA will return at a later date to complete the annual visit. Exit interview conducted and copy of report printed for Backup Administrator.the state’s words, verbatim · CDSS document, Jul 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 9:30 am to conducted a 1 year annual visit to the facility above. LPA met with Back up Administrators Jessica Bailey and Rachelle Tellez and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrators. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Mitigation Plan, Infection Control Plan and Emergency Disaster Plan. The facility has EPA approved disinfectants spray and cleaners. The facility has trash bins with lids/covers. The facility has a 30 day supply of PPE. The facility staff have taken annual Infection control and PPE training. Physical Plant & Environment Safety: The facility is a 6 bedroom and 6 bathroom home currently occupying 5 residents and 7 staff, including 3 administrators. The facility is clean, safe and sanitary. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. Laundry room has working washer and dryer. Operational Requirements: The Facility is operating in compliance with fire clearance. Capacity is 6 with 1 non-ambulatory and 5 bedridden with a hospice waiver for 3. The facility has current liability insurance on file. The facility has dual hard wired smoke and carbon monoxide detectors. Staffing: The facility employes 7 staff and 3 Administrators. Staff records are kept confidential. Staff records were reviewed for 5 staff. Staff records had fingerprint clearance and associations with criminal record statements, personnel record or application, First Aid and CPR certificates and Health screening with TB results. Administrator file has all CEU/education requirements to renew Administrator Certificate, Administrators are on the active or pending list. Continued 9099-C Personnel Records & Training: The facility keeps confidential files for each staff member. Training records were current for required 2024 annual training. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Five Files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. All files reviewed were meeting compliance requirements. Resident Rights Information: All require postings were posted in common areas of facility. Personal rights, Rights to Resident Council, Theft and Loss policy, Non-discrimination notice in addition to a CCL Complaint poster, PIN, License, Hospice Waiver, Emergency Disaster plan and LTCO poster. Planned Activities: The facility offers activities to all residents in care. Activities include arts and crafts, books, magazines, newspapers, TV watching, daily walks, group discussions and communications, and puzzles. The facility has sufficient space to allow for activities indoors and outdoors. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available in the pantry and garage. Incidental Medical & Dental: Facility provides transportation to medical and dental appointments when needed. The medications records were reviewed for all 5 residents with the Centrally Stored Medication and Destruct Records (CSMDR). LPA inspected 5 residents medications, all medications were in the original containers, prescription labels were not altered, and no medications were expired. Doctors orders were present and dispensing instructions were followed. Disaster Preparedness: The current emergency disaster forms were posted. The facility provided quarterly disaster drills for 2023-2024. The fire extinguishers were charged and tags are dated within the last year. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked separately in cupboards. The facility does have hospice and home health visits to the facility for residents in care. Facility is completely fenced with self closing and self latching gates. The facility does not have delayed egress. The facility does not have any residents currently using oxygen. Exit interview conducted, copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jul 9, 2024