Taking the Journey Orchard

Type of visit: Required - 1 Year

02/26/2026, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. There are currently four residents in care. Facility approved/cleared for five non-ambulatory and one bedridden. Facility has a hospice waiver for two. LPA was greeted by staff. LPA and staff toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. All rooms were furnished per regulation. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured and found to be within the range of 105 to 120 degrees F. Fire extinguishers were last inspected January 2026. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Sharps are located in a locked drawer in the kitchen. Chemicals were found to be secured located in the laundry room. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. Facilities last emergency drill was conducted 02/23/2026. LPA conducted a review of four resident records. All records had the required documentation. LPA conducted review of four staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. continued on LIC809C No deficiencies cited during today's inspection. Updated copies of the following documents were requested and are to be submitted to CCL by 03/26/2026: LIC500- Personnel Report LIC308- Designation of Responsibility Updated Liability Insurance Infection Control Plan (review, update if needed) Emergency Disaster Plan (review, update if needed) Exit interview conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 26, 2026

Type of visit: Post Licensing

On 06/05/2025 Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct a Post-Licensing Inspection of facility and was welcomed by staff Alberto Lopez. Staff contacted Administrator Kelly Eriksen who arrived during inspection. Facility is a single-story building with 6 bedrooms, and an approved fire clearance for 6 Non-Ambulatory of which 1 may be bedridden. Hospice waver has been granted for 2. There are currently 6 residents with 1 using Hospice services during the time of this inspection. Facility tour/inspection began at 8:10 AM: LPA toured the indoor and outdoor portions of facility on 6/05/2025; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. The facility has special care plan of operation and programming for residents with dementia. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing, as well night lights for residents. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations. Food is available for residents any time of the day. Cleaning products, sharp items, other toxins and chemicals are kept out of resident access and found secured and stored in the kitchen, laundry room, and shed. There was a supply of cleaners, hygiene products and paper products available for residents. Resident bathrooms had required slip resistant mats and grab bars. Hot water temperature measured between 111.7 degrees F and 115.8 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathroom faucets. All bathrooms at the facility were supplied with paper towels and hand soap. Continue on LIC809-C Continued from LIC809 Fire Extinguisher was found to be last charged on 2/12/2025. Smoke detectors and Carbon monoxide detectors were tested and found to be operational. Facility has video surveillance in common areas, that does not include audio. The back porch of the house has shade and provides a safe and secure area for residents to spend time outside. File Review began at 9:30 AM: A review of six residents & sample review of five staff records as well as two resident’s medications was conducted. LPA learned that 6 out of 6 residents have updated reappraisal/needs & care plan as well as medical assessments. Sample review of 5 staff records revealed staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. All direct care staff have received the additional training requirements; LPA was also provided required proof of CPR & 1st Aid certification. Medication Audit began at 11:00 AM: Medications were centrally stored in locked hallway closet/ medication room. LPA observed medications of 2 out of 2 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to have all medications entered for residents. LPA reviewed Licensing Information System (LIS) with Administrator who stated that is corrected and updated at this time; no need to change any of the information. Disaster Drills will be conducted quarterly and in different shifts with the last one being conducted on 4/18/2025. Facility has 1 large generator that can power ¾ of the house in case of power outage. In addition, Kelly Eriksen, Administrator Certificate # 7008387740 expires 11/5/2025. LPA has requested Licensee to submit Liability Insurance, LIC308 (Designee), & LIC 500 (Personnel Report) to CCL by 6/20/2025. No deficiencies found. No citations issued.the state’s words, verbatim · CDSS document, Jun 5, 2025

Type of visit: Prelicensing

On 03/11/2025 Licensing Program Analyst (LPA) Loera conducted a pre-licensing inspection and was greeted by Licensee Applicant Kelly Eriksen. This pre-licensing inspection is being conducted for an initial licensing. The facility is a one story home with a fire clearance approved for 5 non-ambulatory and 1 bedridden. LPA conducted a tour and inspection of the indoor and outdoor portions of the facility. Facility was found to be clean and comfortable temperature with bedroom doors free from obstruction. LPA observed Fire extinguishers throughout the facility which were last inspected 02/2025. Cleaning products, sharp items, other toxins and chemicals are kept out of resident access and found secured and stored in the kitchen and in the laundry room. Additional supply of hygiene products and linens available to residents. Water was measured at 111.4, 107.4, and 108.3 degrees F in faucets used by residents which is within regulation between 105 & 120 degrees F. Facility has a sample food menu for breakfast, lunch, and dinner. Medications are centrally stored and secured in a locked hallway closet. The facility has all appropriate public documentation and personal rights information posted in common spaces within the facility. Facility's smoke detectors were tested and operational. They were last tested 02/27/2025. LPA confirmed that contents of the facility's First Aid Kit and emergency supplies were sufficient. Component III was reviewed with Applicant. No Deficiencies or Advisories given during visit. Pre-Licensing completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted. This report was reviewed with applicant and a copy was provided to the Licensee.the state’s words, verbatim · CDSS document, Mar 11, 2025