Arianah Place

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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 9:40 a.m. Upon arrival, LPA Mosley was greeted by staff and Administrator and informed them of the visit. The LPA met Administrator Estilito Guevarra and Licensee Representative, Erlinda Gonzalez. Entrance interview. The LPA and Licensee Representative 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. COMMON AREAS: This includes the living 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 1:25 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 12/17/2024. The emergency exiting plans/sketch are posted. 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 08/04/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. 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. BEDROOMS: There are eight (8) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and two (2) staff rooms. The staff rooms are kept locked at all times and observed to be occupied by staff. All six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... RESTROOMS: There are three (3) total restrooms. Two (2) are designated as a shared / common resident restroom, and One (1) is designated as a private resident 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 105.6-116.1 degrees Fahrenheit, all within the required range. GARAGE: The garage is attached to the house. Washer and dryer units are located inside the garage. Emergency water and additional food is located inside the garage. Cleaning solutions, and chemicals are inaccessible and locked away in the garage. LPA observed an additional refrigerator with extra food that was checked for proper labels and expiration dates. KITCHEN: The LPA inspected the kitchen/food service area at 10:08 a.m. Knives and sharps were observed in a locked 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 118.6 degrees Fahrenheit at 10:09 a.m. Cleaning supplies and other chemicals are kept locked under the sink and in the garage, inaccessible to residents in care. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. Only 1 (one) pathway is used as an emergency exit which was free of obstructions at the time of the visit. Resident Records: were reviewed beginning at 10:15 a.m. Five (5) 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, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:01 a.m. four (4) 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. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... 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. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. INTERVIEWS: Starting at 1:20 p.m. one (1) staff and two (2) resident interviews were conducted. 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. MEDICATIONS: Medication review began at approximately 1:30 p.m. Medications are centrally stored and locked in a cabinet in the kitchen adjacent to the dining room. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs 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 during review. DOCUMENTS: Documents obtained during the visit include: LIC 500- facility roster, LIC 9020A -Resident roster, Updated facility sketch and copy of the Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Oct 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at approximately 9:00 a.m. When the LPA arrived, there was two (2) staff members and six (6) residents present. The LPA was greeted by Caregiver, Ashley Cabaneros. and the Administrator, Erlinda Gonzales. LPA informed them of the reason for the visit. Entrance Interview. At 9:53 a.m. the 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. The following was noted: Facility is a single-story residence that consists of six (6) resident bedrooms and three (3) bathrooms. There are two (2) staff rooms. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. During today’s visit the LPA obtained the LIC500 (Personnel Report), LIC9020 (Client Roster) and Liability Insurance. Last emergency drill was conducted on 09/01/2024. Bedrooms: All residents' bedrooms were properly furnished with at least one chair, a bed, night stand, chests of drawers, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. The bedrooms were large enough to allow for easy passage between the beds and furniture. 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. Linens are kept in the closet and each room contains additional linens in resident closets. Continued on LIC 809-C Continued from LIC 809 Bathrooms: LPA observed all bathrooms were clean, sanitary and in operating condition. The bathrooms were sufficiently stocked with soap and paper towels and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. Between 10:00 a.m. and 10:33 a.m. hot water was measured in all three (3) bathrooms. All bathrooms were within the required limit of 105-120 degrees Fahrenheit. Common Areas: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is blocked by a tv console and inaccessible to residents. The facility maintained a comfortable temperature of 71 degrees. LPA observed cameras throughout the common areas only. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. Smoke detector(s) and carbon monoxide detector were tested at 11:15 a.m. and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 12/01/2023. The LPA observed required postings throughout the common space. Kitchen: Kitchen and food service area was inspected during the physical plant tour. Knives and cleaning supplies are stored inaccessible under the kitchen sink. Kitchen appliances were in operable condition during today’s visit. The facility has a sufficient supply of perishable and non-perishable food. At 10:45 a.m., hot water temperature measured at 110 degrees Fahrenheit. LPA observed a complete First Aid Kit and its manual in the kitchen. Surrounding Areas: The front yard is free of obstructions. The backyard has an outdoor area equipped with furniture and shade for client use. There is a side gate for resident use and is single latched. No bodies of water noted at the time of the visit. Garage: The garage is where the washer and dryer are held. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. All cleaning compounds were stored in areas separately from food supplies. Additionally, LPA observed emergency food and emergency water inside the garage. LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. Continued on LIC 809-C Continued from LIC 809-C File review: A review of facility files was initiate at 11:43 a.m. and the following was observed. LPA reviewed six (6) residents’ files. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All residents’ documents reviewed appeared complete and current. Four (4) staff files including the administrator’s were reviewed. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. LPA obtained LIC 500 (Personnel Report) dated on 09/01/2024. A comparison was conducted between the information provided and the results from the Guardian Background Check report, which was ran today, 10/16/2024. On the LIC 500, LPA observed Staff #1 (S1) listed as a Reliever/Caregiver. LPA determined that S1 has a background clearance however is not properly associated to the facility. Records reviewed confirmed that S1 is associated to the licensee’s other facilities. Furthermore, LPA observed Administrator’s CPR certificate has expired. The administrator will renew the certification and provide a copy to the LPA upon completion. All other files reviewed appeared complete and current. Medications: Medications review began at 2:00 p.m.; medications are centrally stored and locked in a cabinet in the kitchen. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Interviews: LPA conducted interviews between 9:45 a.m. and 1:30 p.m., the LPA conducted two (3) staff and two (2) residents’ interviews. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Civil penalty was issued in the amount of $500. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 16, 2024