A Cornerstone Safe Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit today at 09:45 a.m. Upon arrival, there were two (2) staff and three (3) residents present. The LPA met with Administrator, Susan Lumbres and explained the reason for the visit. Entrance interview conducted. Beginning at 09:50 a.m., the LPA along with 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. The following was observed: Kitchen: The LPA inspected the kitchen/food service area at approximately 10:10 a.m. Knives and sharps were observed in a kitchen drawer locked and inaccessible. Cleaning supplies were observed in a locked cabinet at the time of the visit. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Common Areas: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed a fire extinguisher to be new with a purchase date of 12/28/2025. Required postings were observed throughout the common space. There is a working telephone on premises. Fireplace was observed adequately covered. Report Continued on LIC 9099C... Report Continued from LIC 9099... Activities were observed in the living room. Auditory alarms were observed functioning at the time of the visit. At 10:14 a.m., the smoke detector and carbon monoxide were tested and operational at the time of the visit. The LPA observed an adequate amount of emergency food and water. The LPA observed a washer and dryer. Cleaning supplies and detergents were observed locked and inaccessible at the time of the visit. No hazards/obstructions observed inside or out. Restrooms: There are three (3) restrooms for residents use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 09:58 a.m., the hot water temperature was measured in bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit. Bedrooms: There are five (5) bedrooms for residents use. Four (4) bedrooms are designated as private / single bedrooms, and one (1) bedroom is designated as shared / double occupancy. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Additional clean linens and towels were observed in a closet by the hallway. Staff bedroom was observed locked and inaccessible at the time of the visit. Outdoors: The backyard has a covered patio area with adequate furniture for residents’ use. Emergency passageway was observed to be clear of any obstructions. The LPA observed two (2) sheds for storage purposes. There is one (1) side gate with latching mechanisms. No bodies of water noted at the time of the visit. Records: Record review began at approximately 10:20 a.m. Three (3) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, and current needs and services plan. All files were in order. Report Continued on LIC 9099C... Report Continued from LIC 9099C... Three (3) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments with negative TB test results, criminal record clearances, first aid, and the appropriate yearly training. All personnel files were complete. The Administrator’s Certificate is valid until 12/20/2026. Infection Control / Emergency Disaster Planning: The LPA reviewed the facility's infection control plan during today’s visit. The facility’s policies and procedures as they pertain to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; last drill conducted on 01/05/2026. Medications: Medications review began at approximately 12:05 p.m. Medications are centrally stored in a locked cabinet adjacent to the living room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications are properly documented on the centrally stored medication and destruction record. Medications appear to be administered as prescribed at the time of the visit. No citations issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit today. Upon arrival, there were two (2) staff and five (5) residents present. The staff contacted the Administrator via telephone and explained the reason for the visit. The Administrator, Susan Lumbres arrived at 10:35am. Entrance interview conducted. Starting at 10:40am, the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of non-perishable and perishable food; properly stored. Refrigerator and dry food pantry were checked for proper labels and expiration dates. The LPA observed knives and sharps in a locked drawer. Cleaning supplies were observed locked an inaccessible at the time of the visit. At 11:06am, the kitchen sink was measured for hot water temperature, and it measured 113.8 degrees Fahrenheit. BEDROOMS: There are four (4) bedrooms for resident use. Two (2) bedrooms are designated as double occupancy; and two (2) bedrooms are designated as single occupancy. The LPA observed all resident bedrooms to be properly furnished and with sufficient lighting. Additional clean linens and towels for resident use were observed in the hallway closet. Report Continued on LIC 809C... Report Continued from LIC 809... BATHROOMS: There are two (2) bathrooms for resident use. Bathrooms were observed to be equipped with nonskid surfaces and grab bars. The LPA observed bathrooms to be properly supplied and had functional fixtures. Starting at 10:40am., the water temperature was measured in bathrooms, and they measured within the required range of 105 and 120 degrees Fahrenheit. COMMON AREAS: The LPA observed the living room and dining room area to be furnished appropriately and all furniture was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. The LPA observed required postings throughout the common space. Activities for residents were observed in the living room. There is a working telephone on premises. Fireplace was observed adequately covered. Facility has an adequate amount of emergency food and water. At 11:09am, smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. No obstructions or hazards were observed inside or out. BACKYARD / OUTDOOR: There is a shaded area in the backyard with appropriate furniture for resident use. The exterior passageways were clean and clear of any obstructions in case of an emergency. The LPA observed one (1) gate that was latched. No bodies of water noted at the time of the visit. RECORD REVIEW: The LPA reviewed five (5) Resident Records and four (4) Personnel Records starting at 11:13am. Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, and current needs and services plan. All files were complete. Personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR certifications, and yearly training. All records were in order. Report Continued on LIC 809C... Report Continued from LIC 809C... During today’s visit, the LPA conducted interviews with one (1) resident and one (1) staff. No concerns were noted. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Fire extinguisher was observed to be fully charged. Emergency disaster drills are conducted quarterly, with the last one conducted on 01/10/2024. MEDICATION REVIEW: The LPA conducted a medication review at approximately 1:30pm. Medications are centrally stored in locked file cabinets by the living room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. The LPA observed PRN authorization letters for all residents on file. Medications appeared to be given as prescribed at the time of the visit. No citations issued. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Jan 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today. The last annual conducted at this facility was on 02/08/2023. When the LPA arrived, there was one (1) staff and two (2) residents present. The LPA was greeted at the door by staff and the reason for the visit was explained. The Administrator, Susan Lumbres arrived shortly after. Entrance interview conducted. At 8:55 a.m., the LPA along with 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. KITCHEN: The LPA inspected the kitchen/food service area at 9:10 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. The knives and sharps stored in a locked drawer inaccessible to residents in care. Cleaning supplies were also observed locked and inaccessible under the kitchen sink. COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. At 9:21 a.m., the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed to be in compliance and newly purchased on 01/4/2024. The LPA observed a closet in the hallway with extra towels and linens. (Report Continued on LIC 809C...) (Report Continued from LIC 809...) The LPA observed required postings throughout the common space. There is a working telephone on premises. Working auditory alarms were observed in all exit doors at the time of the visit. The washer and dryer were observed inaccessible to residents in care. The facility has a sufficient amount of emergency food and water which was observed to be in good condition. The LPA observed a sufficient supply of Personal Protection Equipment (PPE). BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There was one (1) gate that self-latches. No bodies of water were noted at the time of the visit. BEDROOMS: There are four (4) resident bedrooms. Two (2) bedrooms are single occupancy, and two (2) bedrooms are double occupancy. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are two (2) resident restrooms. The first restroom is located in the hallway and the second restroom is located in bedroom #3. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in both bathrooms and found in compliance as the both measured 110.6 degrees Fahrenheit. RECORDS: Records review began at 9:31 a.m.; two (2) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At 9:48 a.m., records review of Resident #1’s (R1’s) physician’s report dated 10/18/2023 revealed that R1’s ambulatory status is considered bedridden; however, facility is approved for bedridden in Room #4 and R1 is currently living in Room #3 which is approved for non-ambulatory only. (Report Continued on LIC 809C...) (Report Continued from LIC 809C...) Five (5) personnel records 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 complete. The last emergency disaster drill took place on 01/02/2024. MEDICATIONS: Medications review began at approximately 11:15 a.m.; medications are centrally stored in a locked cabinet in the living room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. A $500 immediate civil penalty is assessed today. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 13, 2024