Madelaine Place

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10:20 a.m. Upon arrival, LPA Mosley was greeted by staff and called the Administrator to inform them of the visit. The Administrator arrived shortly after. The LPA met with Administrator Erlinda Gonzales, and Madelaine Gonzales, Assistant Administrator and explained the reason for the visit. The LPA and Administrator 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. The facility is a single-story home located in a residential neighborhood. INTERVIEWS: Starting at 10:30 a.m. and throughout the visit two (2) staff including the Assistant Administrator and three (3) resident interviews were conducted during the inspection. One (1) resident was out in the community and unable to be interviewed during the time of the inspection. Staff interviews revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. COMMON AREAS: This includes the family room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 1:09 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 12/18/2025. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 04/25/2026 and are conducted quarterly. Activities were observed in the common areas. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. Report Continued on LIC 809C PAGE 2... (PAGE 2) Report Continued from LIC 809... LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that one (1) camera of three (3) were functioning properly and that none of them were equipped with audio capability. KITCHEN: The LPA inspected the kitchen/food service area at 10:44 a.m. Knives and sharps were observed and locked in the garage in a cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 106.5 degrees Fahrenheit at 10:45 a.m. Cleaning supplies and other chemicals are kept under the sink locked and inaccessible to residents in care. BEDROOMS: There are six (6) total bedrooms in the facility; all six (6) bedrooms are designated as private, single occupancy, resident rooms. There is no staff room and Administrator stated that staff remain awake at night. All six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Each bedrooms have its own supply of linens stored in the closet. RESTROOMS: There are four (4) total restrooms. One is designated as a shared / common resident restroom, two are designated as private resident restrooms, and One (1) is designated as guest / staff restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 106.5 -106.9 degrees Fahrenheit, all within the required range. LPA observed storage space closets in the hallway containing extra clean linens and towels for resident use. LPA obtained permits for citations issued last year regarding non permitted alteration of a bathroom in bedroom #6. Report Continued on LIC 809C PAGE 3... (PAGE 3) Report Continued from LIC 809C PAGE 2... GARAGE: LPA observed the attached facility garage, accessible through the kitchen which was locked at the time of the visit. LPA observed tools, personal protection equipment (PPE) , incontinent supplies, an extra freezer that was checked for proper labels and expiration dates. LPA observed washer and dryer along with detergent. BACKYARD: The entire property is fenced. The LPA observed the back yard which had four (4) portable outdoor umbrellas for shade along with patio furniture including tables and chairs for resident use. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. Both pathways are used as an emergency exits which were free of obstructions at the time of the visit. RECORDS: Resident Records were reviewed beginning at 11:03 a.m. Four (4) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, Home Health records, Hospice records, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:38 a.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required, 05/25/2026. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 12:01 p.m. Medications are centrally stored and locked in a closet adjacent to the entrance. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were properly documented on the centrally stored medications and destruction record, stored, locked and inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed. No errors observed during review. LPA observed the first aid supplies to be complete, including sterile first aid dressings, bandages, tweezer, a thermometer and a current version of a first aid manual. Report Continued on LIC 809C PAGE 4... (PAGE 4) Report Continued from LIC 809C PAGE 3... DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, copy of the Limited Liability insurance, and permits for alterations / addition of a bathroom in bedroom #6. At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator updated facility phone number and confirmed that all information is accurate. No citations issued at this time. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, May 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9: 45 a.m. Upon arrival, LPA Mosley was greeted by staff and called the Administrator to inform them of the visit. The Administrator arrived shortly after. The LPA met with Administrator Erlinda Gonzales 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. INTERVIEWS: From 9:55 a.m. – 10:16 a.m. One (1) staff and two (2) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. COMMON AREAS: At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 1:11 p.m., smoke detector(s) and carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguishers were observed and fully charged on 12/17/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place sometime in January 2025 and was not documented which poses/posed a potential health, safety or personal rights risk to persons in care. The Administrator was informed about the importance of emergency disaster drills and agreed to conduct a drill tomorrow and submit proof to CCLD. Report Continued on LIC 809C PAGE 2... (PAGE 2) Report Continued from LIC 809... Activities were observed in the common areas. An adequate supply of emergency food and water was observed. The facility has a working telephone on premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits in the home were free of obstruction. Inside temperature was maintained at a comfortable level. KITCHEN: The LPA inspected the kitchen/food service area at 10:16 a.m. Knives and sharps were observed in a locked cabinet under the sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.4 degrees Fahrenheit at 10:21 a.m. BEDROOMS: The facility is a single-story residential home with six (6) bedrooms of which six (6) are for resident use. Resident bedrooms are private, single occupancy. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: The facility has a total of four (4) bathrooms. Two (2) are private resident bathrooms and two (2) are shared, common bathrooms for resident use. Restrooms were clean and sanitary and in operating condition with grab bars and slip resistant surfaces. Hot water was measured in all resident bathrooms from 10:21 a.m. - 10:38 a.m. and measured between 109.8 – 110.8-degree Fahrenheit within the required range. The sinks had sufficient liquid soap, and paper towels. At approximately 10:31a.m. LPA observed that the private bathroom in bedroom # 6 was an alteration and does not have a permit which poses/posed a potential health, safety or personal rights risk to persons in care. OUTDOOR SPACE/ GARAGE: The LPA observed the back yard which had four (4) portable outdoor umbrellas for shade along with patio furniture including tables and chairs for resident use. The LPA observed the right-side gate that self-latches with a clear passageway in case of an emergency. The left side gate was blocked by a ladder, wheel barrel, generator, cart, paint gallons posing an immediate health, safety or personal rights risk to persons in care. Administrator was informed of the dangers and advised to relocate all the items at the time of the visit. There were no bodies of water observed on the premises at the time of the visit. The garage is kept locked and inaccessible to residents. Report Continued on LIC 809C PAGE 3... (PAGE 3) Report Continued from LIC 809C PAGE 2... LPA observed an extra freezer with extra food that was checked for proper labels and expiration dates. Laundry units observed in the garage. Cleaning solutions, laundry detergent, toxins, chemicals, and hazardous items were inaccessible and locked away in the garage. At approx. 10:42 a.m. LPA observed an alteration to the garage of a wall that was added for a staff room that includes a bed, storage space and does not have a permit which poses/posed an immediate health, safety or personal rights risk to persons in care. The facility was cited last year for having a storage area that was converted to a staff sleeping area. The Administrator agreed to not allow staff to sleep in the area and clear out all furniture (bed). RECORDS: Records review began at 10:54 a.m., five (5) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records in order. At 11:40 a.m. five (5) Personnel records including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Infection Control / Emergency disaster planning: During today’s visit LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as they pertain to infection control and emergency preparedness are adequate. MEDICATIONS: Medications review began at approximately 2:03 p.m. Medications are centrally stored and locked in a closet adjacent to the entrance. Medications for four (4) residents were reviewed. Medications are labeled and checked for expiration dates. All medications were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed. Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, and current Liability Insurance. An updated facility sketch was requested. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Zabel Chochian arrived at the facility today to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Erlinda Gonzales arrived shortly thereafter. At approximately 11:00am, LPA and the Administrator 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. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are five designated client rooms. RESTROOMS: The three resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 105 degrees Fahrenheit. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 78 degrees. Smoke detector(s) and carbon monoxide detector were tested at approximately 11:45pm. and operational at the time of the visit. The one (1) fire extinguisher was fully charged and was last serviced 12/01/2023. Required postings observed throughout the common space area. KITCHEN: The LPA conducted an inspection of the kitchen. Knives and cleaning supplies observed stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for residents use. There is a side gate for client use and is single latched. No bodies of water noted. The garage is where the washer and dryer are held, including additional freezer with perishable food items. Cleaning supplies and disinfectants are kept in locked in the garage. RECORDS: Residents’ records review began at 12p.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Hospice care plans and required records for two (2) resident receiving hospice services are not kept at the facility. (Continue to LIC809c). Personnel records review began at 1pm, records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Current staff were missing record of required 20hrs required training and medication training. LPA requested Mrs. Gonzales submit the following documents: - Current copy of the LIC500 Personnel Report - Copy of the Liability insurance. MEDICATIONS: Medications review began at 2:00 p.m.; medications are centrally stored and locked in a closet at the entrance of the facility. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. PRN authorization letter was not obtained/on record for Resident #6 who is currently on PRN medication. Mrs. Gonzales obtained the letter during today's visit and acknowledged understanding the procedures to follow when assisting residents with PRN medications. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. Appeal Rights Discussed. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 3, 2024

The state marks this report as 24 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.