Olive Tree Assisted Living

Type of visit: Required - 1 Year

At approximately 1:45 PM Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a required- 1 Year visit met with Licensee/Administrator Claudia Quijada. There are currently four (4) residents in care, and two (2) residents are on hospice and no residents using PRN or other supplemental oxygen. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Facility has a fire clearance approval for a total of six non-ambulatory residents, of which two (2) may be bedridden. All locks on exterior gates are approved. The self latching fire exit gate is never to have a lock on it. The facility's last fire drill and evacuation drill was conducted 10/21/25. The facility does have emergency food, water, and miscellaneous supplies to meet the "72 hour shelter in place" requirements. Facility was observed to be clean and without odors. Hot water in bathrooms available to residents in care measured between 105-120F as required by regulation. All exits were free and clear of obstruction. Fire extinguisher was serviced and tagged as required on 04/2025. Smoke alarms and carbon monoxide detectors were working properly during the inspection. The backyard has outside cement patio, with furnishings for resident use, including areas providing shade for residents as needed. The facility was at a comfortable temperature for residents in care; Residents were observed to be watching television and engaging with the staff during the inspection. Continued on LIC809C... Continued from LIC809 Toxins and sharps that pose a potential threat to residents in care were observed to be secure and supervised. Medications were observed to be centrally stored and locked and Medicine Administration was observed to be accurate. LPA reviewed four (4) resident files; Resident files were complete. LPA reviewed five (5) staff files. LPA reviewed staff training. All five(5) staff have criminal record clearance, and are associated as required. All staff had current First Aid and CPR Certification. LPA obtained the following documents today for the facilities file: LIC500 Personnel Report LIC9020 Register of Facility Residents LIC610E Emergency and Disaster Plan Evidence of Current Liability Insurance which will expire 02/2026 and licensee was advise to submit to licensing updated Liability Insurance after 02/2026 No Deficiencies are cited Exit interview conducted with Administrator/Licensee Claudia Quijada.the state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 1/15/25 at approximately 10:00am, and met with Licensee/Administrator Claudia Quijada. There are currently five (5) residents in care, and one (1) resident is on hospice services. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Facility has a fire clearance approval for a total of six non-ambulatory, of which two (2) may be bedridden. All locks on exterior gates are approved. The self latching fire exit gate is never to have a lock on it. The facility's last fire drill and evacuation drill was conducted 10/15/24 & 7/1/24. The facility does have emergency food, water, and miscellaneous supplies to meet the "72 hour shelter in place" requirements. LPA reviewed five (5) resident files; Resident files were complete. LPA reviewed five (5) staff files. LPA reviewed staff training. All five(5) staff have criminal record clearance, and are associated as required. All staff had required training. All staff had current First Aid and CPR Certification. Hot water checked at 116.6 degrees Fahrenheit, which is within regulation. All exits were free and clear of obstruction. Fire extinguisher was serviced and tagged as required. Smoke alarms that are also carbon monoxide detectors were working properly during the inspection. The backyard has outside cement patio, with furnishings for resident use, including areas providing shade for residents as needed. The facility was at a comfortable temperature for residents in care; Residents were observed to be watching television and engaging with the staff during the inspection. Continued on LIC809C... LPA observed sufficient supply of food, perishable and non-perishable, for resident meals/snacks. Facility had sufficient furnishings for residents in care. The facility has sufficient lighting in all rooms, bathrooms, and common areas, including night lights. There was a sufficient supply of hygiene products, cleaning supplies, personal protective equipment (PPE), and paper products for use as needed. All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed. All medications were stored/locked and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. LPA is requesting the following documents be updated and submitted by 2/15/2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E- Emergency Disaster Plan (ensure to review and update as needed/required) LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Copy of current Administrator Certificate The following deficiency was observed by the LPA during the inspection: Per file reviews and interviews, the Licensee has not submitted required incident reports/death reports; There is no proof that these reports were submitted to the licensing office, per file reviews. This deficiency will be cited, 87211-Reporting Requirements(a)(1)(2)-Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: 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 specified in (A) through (D). This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case, see LIC809D. Continued on LIC809C.. LPA observed numerous items stored in the food pantry that were open and not stored appropriately to ensure no contamination of the food items, observed were bags of flour, rice, crackers, chocolate mix, and other miscellaneous items. LPA discussed Food Service regulation with the Administrator in regards to storage of food items. This deficiency will be cited, General Food Service Requirements 87555(b)(28)- All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights given to the Administrator/Licensee. Exit interview conducted with Administrator/Licensee Claudia Quijada.the state’s words, verbatim · CDSS document, Jan 15, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Alviso conducted a pre-licensing inspection, at approximately 9:45am on 1/9/23, and met with Applicant Claudia Quijada; Claudia has a residential care for the elderly administrator certificate, #6060386740, expires 8/24/25. This application is a change of ownership, the facility is currently licensed as Green Meadows Living, #496803963. Facility has a fire clearance approval by the Santa Rosa County Fire Department for a total of six (6) capacity, four (4) non-ambulatory and two (2) bedridden-effective 11/16/2023. Bedridden rooms are #4 and #5 only. Applicant has applied for approval of a dementia plan of operation. Applicant has also applied for an approval of a hospice waiver for two (2). Applicant has submitted a required infection control plan, and a required emergency & disaster plan as part of their application packet. Facility will operate with an awake night staff, and Licensee will ensure sufficient 24/7 staffing at all times. Hot water was checked at 114.8 degrees Fahrenheit, which is within regulation. All exits were unobstructed in the home. All exit doors had auditory alarms and the alarms were working properly during the inspection. Fire extinguisher is serviced and tagged as required- expires 12/29/24. There are nine(9) smoke alarms that are also carbon monoxide detectors, all were working appropriately. Facility has a sufficient supply of food, perishable and non-perishable LPA observed sufficient supply of cleaners, paper products, hygiene products, and personal protective equipment (PPE). There is a large laundry room for storage, cabinets for laundry soap, and other cleaning items. Three is a large metal cabinet for the storage of resident medications; Applicant stated that the laundry room door is to be kept locked at all times to ensure residents don't have access to these stored items. Continued on LIC809C... The facility does have emergency food supplies, and emergency supplies, to meet the "72 hour shelter in place" requirements. There was sufficient lighting throughout the facility in resident rooms, common areas, bathrooms, and hallways. The grounds were free of any apparent hazards, and exits were clear. No bodies of water. No firearms. All bathrooms had grab bars for resident use. Postings noted to be current and in compliance with regulations. Facility does have a generator that can be used as needed for charging things like cell phones, batteries, lights/lanterns. There is a sign in and sign out log at the front door. All postings required were posted, and visible upon entry into the facility and during the facility tour. LPA conducted a component III orientation with Applicant Claudia Quijada. Pre-Licensing is complete and this facility has no apparent hazards to health and safety observed by the inspecting LPA, today, 1/9/24. The facility sketches for the outside and inside have been revised to include changes that were made to the outside backyard property, and in the facility, an added room on the 2nd floor. LPA notified application unit Analyst of physical plant changes; Fire clearance inspection has been requested by the application unit as required. LPA will forward a copy of the completed inspection to the Application Analyst. Application Analyst will notify the applicant of the status of the application.the state’s words, verbatim · CDSS document, Jan 9, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Change in Ownerhip (CHOW) Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Claudia Quijada, Applicant/Administrator Interview Method: Telephone interview On November 4, 2023 Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. 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. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant/Administrator. Report sent via email and informed to return sign copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Dec 4, 2023