Heritage Park

Type of visit: Required - 1 Year

LPA Jeung toured facility and grounds of this one level facility, which consists of six private client bedrooms, a staff break room/office, three full bathrooms, kitchen, dining room and living room. There is an enclosed patio that is accessed from rear hallway, and there are two locked storage units in the fenced backyard. Washer and dryer are located in the hallway near the kitchen; there is no garage. There are no accessible bodies of water or fire safety hazards observed. Sharps are stored appropriately and inaccessible to clients, and a comfortable temperature is maintained. Hot water temperature is tested at 111 degrees F in front bathroom. Carbon monoxide detector is tested and operable. Food supply and first-aid kit are inspected. Client files are reviewed, including Centrally Stored Medications Records. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff training. Mercedes Holloway (x 6/28), Tom Eiseman (x 4/28) and Katie Eiseman (x 1/27) are certified RCFE administrators that oversee facility operations. Personnel report (LIC500) is provided to LPA today. Proof of current liability insurance coverage is requested to be sent to CCLD BY 9/29/26. No deficiencies are cited. See Technical Advisory Notes--5 pages--for additional information. Facility is operating in substantial compliance with CA Code of Regulations, Title 22 for RCFEs.the state’s words, verbatim · CDSS document, Sep 16, 2026

Type of visit: Prelicensing

Applicant Almacare Inc. has submitted RCFE application for 6 non-ambulatory elderly residents. Fire clearance has been granted. Facility is currently in operation under license #415600561 and licensed to Heritage Residential Care, Inc. and Almacare Inc. LPA Audrey Jeung inspected building and grounds, 2-day perishable and 7-day non-perishable food supply, dishes, utensils, equipment necessary for the storage, preparation and service of food, linen supply, checked hot water temperature in main client bathroom at 114 degrees. Carbon monoxide detectors are tested and operable. There is no signal system installed, as night staff are awake. Client files are reviewed in conjunction with annual inspection of licensed facility #415600561, and first-aid training for staff is reviewed. Items referenced in Emergency Disaster Plan are reviewed This facility is essentially one level, with six private client bedrooms, a staff break room with a bunk bed, three full bathrooms, kitchen, dining room and living room. There is an enclosed patio that is accessed from rear hallway, and there are two locked storage units in the fenced backyard. Washer and dryer are located in the hallway near the kitchen; there is no garage. Medications are stored in locked cabinet in front hall, and toxic cleaning products are locked in rear hall cabinet. The following items must be installed, repaired, or resubmitted to CCL prior to approval for licensure: 1. There is a hole in wall behind bed in room #6. (Section 87303 Maintenance and Operation) 2. Screen door to enclosed patio is ripped. (Section 87303) 3. Facility has not yet provided an internet capable device designated for client use. (HSC 1569.319) 4. Utility shut off locations are not accurately described on Emergency Disaster Plan (LIC610E). Continued on next page. The aforementioned items must be addressed prior to licensure, and LPA will be notified upon correction. Facility phone number is 650/344-1855.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Change of Ownership Capacity: 6 Census (if any clients in care): 6 COMP II Participants: MERCEDES HOLLOWAY, THOMAS EISEMAN, KATIE EISEMAN Interview Method: Telephone interview On August 20, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Aug 20, 2025