Tina's Gentle Care Homes II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 11:49 a.m. to conduct a 1-year annual visit to the facility above. LPA met with Licensee Valentina Roberts 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: Physical Plant & Environment Safety: The facility is 4 bedrooms and 3 bathrooms. The facility occupies 4 residents and employs 5 full-time staff of which one is the Administrator and one is a back-up administrator, with 4 relief staff. The facility is clean, safe and sanitary. The facility has smoke and carbon monoxide detectors which were tested and working properly at time of inspection. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to residents. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade. The facility has telephone and internet service for residents’ use. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 09/21/26. Staffing, Personnel Records & Training: LPA reviewed staff files. Files were reviewed for, but not limited to current 1st Aid/CPR, Personnel Records/Application, and Health screening with TB results. Administrator Certificate expires on 10/27/27. All files were kept up to date with all requirements being met. LPA reviewed staff training records for Annual Training Requirements of 20 plus hours and 8 hours of Medication training. Continued 809-C Resident Records & Incident Reports: Four (4) files were reviewed for, but not limited to signed Admission Agreements, Medical Assessments, LIC 602A Physicians Report, ID and Emergency contact forms, and Appraisal Needs and Services plans (ANS). The facility does not handle cash resources. Incidental Medical & Dental: The facility has a medication cabinet that is kept locked. Facility provides or assist in providing transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA reviewed a sampling of residents’ medications, no medications labels were altered, no expired medications, and medications were stored in original containers. 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. Kitchen areas are kept clean. Disaster Preparedness: The current emergency disaster forms were reviewed. The facility conducts quarterly disaster drills. The fire extinguishers were charged last inspected in 2/18/26. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger such as sharps, and cleaners were inaccessible to residents in care. The facility does not have delayed egress. The facility does not currently have residents with oxygen. The facility has 1 resident currently on Home Health services. The facility has 1 resident on hospice. The facility gate is self-latching and has self-closing equipment on one side. The backyard is completely fenced. The facility has exiting door alarms, which were working on LPA's visit. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, May 14, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melisa Rankin arrived at 11:47 a.m. unannounced to conduct a one year required annual. LPA met with Licensee Valentina Roberts and Administrator Michael Joseph Elizarde and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Kitchen: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. All food is covered, stored and marked appropriately. Kitchen areas are kept clean and free from litter, insects and pests. Cleaning supplies and disinfectants are stored under the sink and in the garage, inaccessible to clients. Knives are stored in a locked cabinet in the kitchen. Common areas: Living and dining room furniture were observed to be in good condition. Carbon monoxide and smoke detector were tested and operational at the time of the visit. LPA observed required postings throughout the common space. The backyard had a table and umbrella. No bodies of water noted. The washer and dryer are in a laundry room. Restrooms: The three (3) restrooms were clean and sanitary and in operating condition with non-skid mats. Secured grab bars were present. Bedrooms: There are four (4) resident rooms, which were furnished with appropriate furnishings. Linen cabinets were located outside of the rooms, which stocked extra linens and towels. Continued on 809-C Operational Requirements: Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 09/21/25. Records: LPA reviewed resident and staff records. Five (5) resident files were reviewed for, but not limited to, the following: 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. The facility does not handle cash resources. The LPA reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. Administrator Certificate expires on 10/27/25. All files were complete. LPA reviewed five (5) staff training records for Annual Training Requirements of 20 plus hours. Trainer met the requirements to train staff. Medications: Medications are centrally stored and locked in a cabinet in the kitchen / second living room. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA reviewed a sampling of resident’s medications, no medications labels were altered, no expired medications, and medications were stored in original containers. Disaster Preparedness: The current emergency disaster forms are accessible to staff and emergency phone contacts are posted. The facility conducts quarterly disaster drills. The fire extinguisher were charged and inspected in February of 2025. A set of keys is available for staff on all shifts to access full facility in an emergency. Exit interview conducted. A copy of the report was printed.the state’s words, verbatim · CDSS document, May 16, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melisa Rankin arrived unannounced to conduct a one year required annual. LPA met with Licensee Valentina Roberts and Administrator Michael Joseph Elizarde and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Kitchen: The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored and marked appropriately. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Cleaning supplies and disinfectants are stored under the sink and in the garage, inaccessible to clients. Knives are stored in a locked cabinet in the kitchen. Common areas: Living and dining room furniture were observed to be in good condition. Carbon monoxide detector was tested and operational at the time of the visit. LPA observed required postings throughout the common space. The backyard had a table and umbrella. No bodies of water noted. The washer and dryer are in a laundry room. The laundry room which access the garage is locked. Restrooms: The three (3) restrooms were clean and sanitary and in operating condition with non-skid mats. The bathrooms were sufficiently stocked with soap and paper towels. Bedrooms: There are four (4) resident rooms, which were furnished. Linen cabinets were located outside of the rooms, which stocked extra linens and towels. Continued on 809-C Operational Requirements: Facility is operating in compliance with the granted fire clearance based on the facility sketch. The facility has current liability insurance and expires on 09/21/24. Records: LPA reviewed resident and staff records at 11:45 p.m. Four (4) resident files were reviewed for, but not limited to, the following: 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. The facility does not handle cash resources. The LPA reviewed four (4) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. Administrator Certificate expires on 10/27/25. All files were complete. LPA reviewed 4 staff training records for Annual Training Requirements of 20 plus hours. Trainer met the requirements to train staff. Medications: Medications are centrally stored and locked in a cabinet in the kitchen/living room. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected medication cabinet for all prescription and PRN medications with Doctors orders. LPA reviewed a sampling of residents medications, no medications labels were altered, no expired medications, and medications were stored in original containers. Disaster Preparedness: The current emergency disaster forms are accessible to staff and emergency phone contacts are posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and inspected in February of 2024. A set of keys is available for staff on all shifts to access full facility in an emergency. Infection Control: The facility has an infection control plan The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Exit interview conducted. A copy of the report was printed.the state’s words, verbatim · CDSS document, May 20, 2024