Evergreen Residential Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with licensee/administrators (LIC/ADM) Dante Devano and Belinda Devano. LPA stated the purpose of the visit. The facility is licensed to serve adults 60 and over, approved for 5 non-ambulatory of which 2 may be bedridden to reside in bedroom #3 and #6 only. Licensee is subject to terms and condition of the hospice waiver for 5. LPA observed 6 residents at the facility, 2 out of 6 was having their breakfast in the dining room, 1 out of 6 was in the living room watching the news and 3 out of 6 was in their respective bedroom. 4 Out of 6 is under hospice care and 1 out of 6 is bedridden. LPA observed 4 staff at the facility and was assisting residents. LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, garage and outdoor spaces and storage areas. Indoor temperature was within acceptable range of 70°F. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). Kitchen water temperature measured at 114.4°F. Bathroom water temperature ranged from 114.°F to 114.4°F. LPA inspected 6 residents bedrooms and 3 bathrooms. 6 out of 6 bedroom has functioning lights, storage for personal belongings, clean linens. Bathrooms have grab bars and non-skid mats. Oxygen tanks were empty and stored in a safe place. Oxygen is used by residents under hospice when needed or required. Medications were locked and inaccessible to residents; first aid kit was complete and easily accessible to staff. LPA observed, that night lights were functional all throughout the indoor walkways and bathroom. Indoor walkways were free from tripping hazards and obstructions. LPA observed that the facility is equipped with fire pull alarm system, smoke and carbon monoxide alarm that are operational. The facility conducts fire and earthquake drill quarterly for each shift. Last drill practice training was on 01/02/26, 04/02/26 and 07/02/26. The facility is equipped with wall panel fire alarm system and 2 fire extinguisher were inspected on 05/22/2026. The facility has a fenced in backyard pool with heater that is maintained and gate is kept locked at all times. All exterior walkways were kept maintained and free from obstruction and tripping hazards. Exit gates were free from obstructions. Emergency exit doors were kept free from any obstructions and doors were functioning properly. LPA reviewed resident and staff records, including medication logs, admission agreements, care plans, personal and incidentals, health screenings, and training for special health needs and providers hospice training. LPA verified that LIC/ADM has a valid medical professional license. All staff have required clearances and certifications. LPA reviewed the facility file and records were updated and current. No deficiencies were cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted and a copy of the report was provided to LIC/ADM Dante Devano & Belinda Devano.the state’s words, verbatim · CDSS document, Aug 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Administrators Belinda and Dante Devano. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and observed locked cabinets that stored cleaning supplies and sharp objects. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA reviewed the first aid kit and found it to be complete. During visit, staff triggered the facility smoke detector system and the carbon monoxide detector and LPA observed that they functioned properly when tested. LPA toured six out of six resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA toured three out of three resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured from 112 F to 116 F. LPA toured the outside area and observed the outdoor exit to be free of obstructions. LPA reviewed six out of six resident records, including Centrally Stored Medication and Destruction Records, and found them to be complete. LPA reviewed six staff records and found them to be complete. The Emergency Disaster Drill Log indicates the last drill was conducted on 07/03/2025. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Belinda Devano and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 20, 2025

Type of visit: Collateral

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct a collateral visit to follow-up on an investigation for a resident who was newly admitted to this facility. LPA met with Administrator, Belinda Devano. During visit, LPA interviewed resident (R1) and obtained R1's medical records and physician's report. No deficiencies were cited per California Code of Regulation, Title 22. This report was reviewed with Administrator, Belinda Devano and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 25, 2025

Type of visit: Required - 1 Year

8/23/2024 at 1:20 p.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year inspection. LPA was greeted by 2 staff and LIC/ADM arrived 10 minutes after LPAs arrival. LPA met with licensees/administrators (LIC/ADMs) Dante Devano & Belinda Devano. LPA stated the purpose of the visit. The facility serves adults 60 ad over, approved for 5 non-ambulatory, of which 2 may be bedridden. Bedridden to reside at room #3 and #6 only and hospice waiver for 5. At 1:30 p.m. LPA with ADMs toured the facility inside and outside including the resident's bedrooms, bathroom, kitchen, garage, dining room, living room, exterior perimeter and backyard. Bedrooms and bathrooms were observed to be organized and sanitary. Bedrooms has sufficient storage for resident's personal belongings. 3 of 6 resident bedroom are equipped for hospice care. 3 of 3 Bathrooms inspected are equipped with grab bars and nonskid floor mats, sanitary and organized. The kitchen, dining and living room are kept organized, sanitary and free from debris. No sharps, knives and chemicals are kept in the kitchen. Knives and sharps are in a locked cabinet. LPA observed 2 days worth of perishables and 7 days worth of nonperishable food. The kitchen sink hot water measured with the digital thermometer at 124.9 degree F and witnessed by LIC/ADM. LPA advised ADM for taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. LIC/ADM have created the warning sign for the kitchen sink and prominently displayed the sign during the time of inspection. Hallways and passage way from kitchen, living room, emergency exit doors are free from obstruction. Facility temperature is maintained at 78 degrees F. Hot water temperature was measured in the 2 bathrooms with a digital thermometer witnessed by the LIC/ADM at 110.7 degree F to 110.9 degree F. page 1 of 2 Facility is equipped with comfortable lighting. The first aid cabinet is located in the dining room, can be easily accessed by staff with the first aid manual. Resident's medication are in a locked cabinet, accessible only to staff who are trained and authorized to administer medicines. LPA observed a laundry room that is kept organized and free from laundry supplies. The laundry room is connected to the garage which was kept organized and free from debris and obstruction. LPA observed a pool surrounded by a fence that is locked and not accessible to residents. The pool is maintained and ready for use at any time by residents with supervision only. The shed storage is locked and not accessible to residents. Fire and earthquake drill was conducted on 1/6/24, 4/6/24 and 7/6/24. Fire extinguisher was last inspected on 6/4/2024. The facility is equipped with a wall fire alarm system that notifies the fire department. The facility is equipped with carbon monoxide and smoke alarm system that are in good working condition. LPA reviewed 3 of 6 residents and 4 of 9 staff records. Facility staff have criminal record clearance to work at the facility and associated to the facility. Facility staff have annual required training and current first aid certificates. Residents centrally stored medication record and destruction (CSMDR) are current and up to date. No deficiencies were cited during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Licensees/Administrators Dante Devano & Belinda Devano and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 23, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.