Juliette's Gardens (Rose)

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Co-Administrator, Joy Clavo-Perez and stated the purpose of today's visit. LPA Rai observed 2 staff and 5 residents at the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 5 resident rooms, 1 staff room, living room, dining room and kitchen. 5 Out of 5 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom sink ranged from 106.8 - 108.2 degrees F. Fire extinguisher was observed and inspected on 02/03/2026. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 04/20/2026 and 08/25/2026. LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Co-Administrator, Joy Clavo-Perez and a copy of the report was provided. LIC 858 and LIC 859 were provided.the state’s words, verbatim · CDSS document, Sep 23, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Lead Caregiver, Lisa (Noveliza) Manzanilla (S1). During the visit, LPA observed 5 residents and 2 staff. LPA explained the purpose of the visit. LPA contacted facility ADM via phone call at 10:36am, no answer. LPA left voicemail informing ADM of visit. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured to range from 108-112 degrees F in resident bathrooms. Fire extinguisher was serviced in January 8, 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on August 18, 2025. S1 stated that was the only drill conducted in 2025. Page 1 Out of 2. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 1 residents. LPA requested a copy of the following documents be sent to LPA by September 24, 2025 1. LIC500, Personnel Summary 2. LIC308, Designation of Administrative Responsibility 3. LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. Qualifications of Administrator (Certificate) Deficiencies are being cited during today's visit. This report was reviewed with Lead Caregiver, Lisa (Noveliza) Manzanilla and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Sep 17, 2025

Allegation investigated: Licensee did not ensure residents records are complete and current. Staff does not have 40 hours of required training The facility is not meeting residents Recommended Dietary Allowance. Facility placed cameras in the facility without the residents/ responsible party's consent. Staff assisting residents with self-administration of medication do not have required medication training. Facility not providing activities which foster and maintain independent functioning Facility has rodents

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator and stated the purpose of today’s visit. On 10/31/2023 the Department received a complaint with the above allegations. On 11/6/2023, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 4. Unfounded Page 2 of 4. Licensee did not ensure residents records are complete and current. /Staff does not have 40 hours of required training. / Staff assisting residents with self-administration of medication do not have required medication training. On 11/6/2023, the LPA reviewed 3 staff files and 3 resident files. All files were complete and current, including the required training for staff and medication training. Administrator (ADM) worked on R1 and R3’s physician to update LIC 602A’s Physician’s Order at the time of the visit. This was a plan of correction ADM was working on as a result of a deficiency cited during facility’s annual inspection on 9/21/2023. Facility placed cameras in the facility without the residents/responsible party’s consent. On 9/21/2023, during the facility’s annual inspection, LPA observed cameras in resident’s rooms which were placed without resident’s consent. ADM’s plan of correction was to remove the cameras until written consent was provided by resident and/or resident’s responsible party. On 11/6/2023, the Department interviewed ADM. ADM stated on 9/21/2023, after facility’s annual inspection, ADM removed all cameras in the facility. During visit on 11/6/2023, the LPA did not observe any cameras at the facility. The facility is not meeting residents Recommended Dietary Allowance. On 11/6/2023, the Department interviewed two staff (S1-S2) and ADM. Three out of three staff stated there is an established food menu which accounts for resident’s requests and any special diets the residents require based on the physician’s order. Page 3 of 4. On 11/6/2023, the Department interviewed 3 residents. Three out of three residents stated the food was okay and they did not have any complaints regarding the food served at the facility. During the visit on 11/6/2023, the LPA observed the facility food supply where the facility had a variety of food, including fruits, vegetables, and canned foods. LPA also observed lunch service and residents were served chicken pot pie and a bowl of fruit. Facility not providing activities which foster and maintain independent functioning. On 11/6/2023, the Department interviewed two staff (S1-S2) and ADM. Three out of three staff stated the facility staff provide activities such as walks, playing cards, read books, watch tv or sports. Staff S1 stated the residents have physical therapist visitations at the facility and staff will encourage the residents to exercise their arms and legs. Staff S2 stated the staff will interact and mingle with the residents as well. On 11/6/2023, the Department interviewed 3 residents. Two out of the three residents stated the facility provide activities and they are satisfied with activities provided. One out of the three residents did not answer any questions regarding facility providing activities. During the visit on 11/6/2023, the LPA did observed residents watching tv and later observed staff S1 take resident R1 and R2 for a walk outside of the facility. Facility has rodents. On 11/6/2023, the Department interviewed two staff (S1-S2) and ADM. Three out of three staff stated they have not seen any rodents in the facility and have not heard of the residents complain or mention seeing rodents in the facility. Page 4 of 4. On 11/6/2023, the Department interviewed 3 residents (R1-R3). Three out of three residents stated they have seen or heard any rodents in the facility. During the visit on 11/6/2023, the LPA toured the facility and did not observe rodents or rodent feces/droppings. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator and a copy of the report was provided. Page 2 of 2. Based on facility file, the facility has an Infection Control plan in place to manage outbreaks and other infections in the facility. During today's visit, LPA Rai interviewed two staff (S1-S2). Two out of two staff were able to provide information regarding facility's infection control policy, cough etiquette and hand washing procedure. During today's visit, LPA Rai observed a third party vendor who was disinfecting the facility, including but not limited to resident bedrooms, bathrooms, living room, kitchen, and outdoor space. Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 25, 2024 · control 26-AS-20231031142449

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Oct 2, 2024

87211 Reporting Requirements (a) (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events... This requiement is not met as evidenced by: Based on interview and record review, ADM did not ensure to report was submitted to the licensing agency when resident being hospitalized after a fall and when two out of three residents had scabies at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2024

Plan of correction: Administrator was not present during today's visit. Administrator stated to submit a written plan of action understanding regulation and ensure Incident Reports are submitted to licensng agency by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Lead Caregiver (LC) Lisa (Noveliza) Manzanilla and stated the purpose of today's visit. LPA Rai observed 2 staff and 5 residents at the facility. LPA Rai spoke with Administrator, Jonathan Perez over the phone and obtained verbal authorization for Lead Caregiver to sign the report on his behalf. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 1 shed which was locked, inaccessible and was used as storage and not habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured 5 resident bedrooms and 1 staff room. 6 Out of 6 resident bedrooms had available bedding, drawers, and functioning lights. LPA Rai observed resident R1's room and exit door located in the room. LC removed a pole from the bottom of the screen door which restricted resident from using the exit door. LC stated R1 exhibited exit seeking behaviors. LPA Rai observed a working door alarm on the exit and the door had locking capabilities. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 105.1 - 105.9 degrees F. The water temperature in the kitchen sink was 105.1 degrees F. Fire extinguisher was observed and inspected on 01/26/2024. The last disaster drills were conducted on 07/30/2024, 07/31/2024, and 8/1/2024. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed facility records for 3 staff and 3 residents. LPA Rai reviewed resident medications and central stored medication records. Deficiencies were cited per California Code of Regulations, Title 22. Technical Assistance was provided. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Lead Caregiver (LC) Lisa (Noveliza) Manzanilla and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Sep 25, 2024