Alta Loma Board and Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Caregiver, Lailani Pineda and was granted entry to the facility. Caregiver Lailani notified the administrator of my arrival. LPA was accompanied by Gina Cayanan to conduct a general overall inspection, which included, but was not limited to, the following: The facility has 5 bedrooms, 2 1/2 bathrooms, 1 staff bedroom, kitchen, dining area, living room, laundry area, garage and backyard. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). LPA observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 Degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 108.5 and 106.2 Degrees Fahrenheit. The facility has operational smoke detector or carbon monoxide alarms. The facility has charged fire extinguisher. LPA observed the facility has a first aid kit, and first aid book, all component available and accounted for. ***LIC809 continued*** LPA reviewed 3 out of 3 staff files and all 3 files were complete. LPA reviewed staff files for Criminal Background Clearance, Health Screening Report, TB test and test results, required training, and CPR/First Aid. LPA reviewed and audited 2 out of 2 residents files for Admission Agreement, Physicians Report, and Needs and Service Plan. LPA observed 1 out of 2 residents was missing a current Physician report. The last documented report was dated 4/6/2024. A Deficiency cited. At approximately 4:30 PM, LPA conducted a Medication audit. During the course of the audit LPA observed medication that was discontinued still being stored with dispensed medication. Medication that has been dispensed missing initials. Medications not accurately logged on the medication MARs sheet. This was PRN and daily prescribed medications. A Deficiency cited. LPA conducted a review of the facility file: Liability Insurance, Emergency Disaster Plan, Infection Control Plan, Resident Roster (LIC9020) Personnel Roster (LIC500). The facility did not have the Infection Control Plan (LIC9282) or manual for review. A Technical Violation issued. LPA observed the facility did not have a current Liability Insurance policy. Licensee stated they were in the process of negotiating the price. A Deficiency cited. LPA observed that the facility is conducting quarterly emergency drills. During this visit three (3) deficiencies and one (1) technical violations, were cited per title 22, chapter 6 of the California Code of regulation. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV, and appeal rights were discussed and copies were provided to Licensee Gina Cayanan.the state’s words, verbatim · CDSS document, Apr 1, 2026

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow made an visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Staff, Lailani Pineda and was granted entry to the facility. Staff Lailani notified the administrator of my arrival. LPA was accompanied by Gina Cayanan to conduct a general overall inspection, which included, but was not limited to, the following: The facility has 5 bedrooms, 2 1/2 bathrooms, I staff bedroom, kitchen, dining area, living room, laundry area, garage and backyard. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). LPA observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 114.7, 121.7 and 120.7 degrees fahrenheit. LPA advised licensee to monitor the water temperature. A technical advisory issued. LPA observed the facility does not have operational smoke detector or carbon monoxide alarms. A deficiency was cited. LPA observed the facility was not equipped with operational fire extinguisher it was last purchased or charged on 2/13/2024. A deficiency was cited. LPA observed the facility has a first aid kit, the kit was missing a current first aid book. LIC809 continued The first aid material was dated 2007. A technical violation was issued. Posters such as; the personal rights, CCL complaint poster, ombudsman, and license were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secure cabinets inaccessible to residents. LPA observed the resident medication cabinet was not locked and observed the licensee remove resident medication from a cabinet with dishes and was unsecured. A deficiency was cited. LPA observed Residents/Staff files were observed in the staff office area and made inaccessible. There are no bodies of water, firearms or ammunition in the facility. LPA observed the living room area exit to the backyard was blocked and obstructed by walkers and lounge chair. LPA requested the those items be removed immediately due it being a safety hazard. A deficiency was cited. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: LPA observed 2 days of perishables and 7 days non-perishables food, pantry stocked and up to date. Facility has a variety of food available. Dishes, cups, and utensils were stored properly. Yards/Outside: One shaded patio, a side gate with entrance/exit to the facility the right side of the facility. Around 10:10AM, while touring the backyard LPA observed tree branches hanging very low blocking your ability walk freely. A deficiency cited. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. LPA observed the facility did not have a sufficient amount of hygiene product for residents in care, and some item are stored in staff common area. A technical violation issued. LPA observed the facility did not have a emergency to go bags for residents in care. A deficiency cited. Record Review: LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. LIC809C Continued LPA reviewed 3 out of 3 staff files and all 3 files were incomplete, or missing health screening and training record and current CPR records. Technical violation issued. LPA reviewed and audited 2 out of 2 residents medication and the audit was complete and matched the MARS. LPA observed that the facility last reviewed the emergency disaster plan on 03/01/2025. LPA observed that the facility did not have a record of quarterly emergency drills. A deficiency cited. Five (5) deficiencies and three (3) technical violations, and one (1) technical advisory were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV, LIC9102TA were discussed and copies were provided to Administrator Gina Cayanan.the state’s words, verbatim · CDSS document, Mar 7, 2025

The state marks this report as 10 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst, Amber Coleman, (LPA) arrived unannounced tot the Alta Loma Board & Care, Residential Care Facility for the Elderly, to conduct the Annual Inspection. LPA was greeted and granted entry by Caregiver, Lani Trinidad. Ms. Trinidad informed LPA that the Administrator had just stepped out and will return shortly. LPA thanked Ms. Trinidad and was provided a space to work. Administrator, Gina Cayanan arrived later during the visit who accompanied LPA on a tour of the facility. The facility is a residential Home comprised of 5 bedrooms, 2 bathrooms, kitchen, dining room, Living Room, Den (Staff Office/Lobby), backyard and attached garage. LPA conducted a general inspection, which include, but was not limited to the following: Physical Plant - The facility is approved for 6 residents. Five, (5) non-ambulatory residents and one, (1) bedridden resident. The facility maintains both a Dementia and Bedridden Care Plan. LPA observed the facility maintained at 73 degrees Fahrenheit - comfortable temperature. Interior pathways were free of clutter and obstructions. LPA inspected 4 resident rooms. Each room contained all required furniture such as sufficient storage space, lighting, bed with proper linens, night stands and seating. There are 2 bathrooms. Each bathroom was equipped with handrails, non-slip grip rugs, and adequate amounts of hand hygiene and paper supplies. LPA observed a fully charged fire extinguisher - last inspected February 2024. The facility is also equipped with operable fire and carbon monoxide alarms throughout the facility. Tested during visit. Food Service: LPA observed the kitchen. Non-perishable and perishable food supply is sufficient for number of residents in care. Food items observed: canned goods in good standing, meats, fresh fruit, milk, eggs and bread. Facility maintains a posted food menu. Sufficient amounts of dishes, cups, and utensils were also observed and stored properly. Chemicals, Cleaning Supplies, Medications and Sharps/Dangerous Objects were observed in the kitchen to be kept in secure places inaccessible to residents in care. Water Temperature measured in the kitchen found within regulatory limits. -Please see LIC809-C Care & Supervision: Facility has sufficient care staff for coverage 7 days a week and 24 hours a day. The facility maintains a staff room available to those who may need it. LPA reviewed Staff Records and observed the following: Criminal Record/Fingerprint Clearances, Health Screenings, Personnel Records. Staff Training included: Dementia Care, First Aid/CPR, Activities of Daily Living, Fall Safety, Medication Management, and Disaster Training. Posters such as: Resident/Personal Rights, Resident Council, See Something / Say Something, Facility Sketch with disaster/evacuation plans, Facility License and Long Term Care Ombudsman were posted in a prominent place. Record Review: Facility Records, Staff and Resident files are maintained securely in the Staff Office Area. LPA reviewed resident files for Admission Agreements, Updated Physician Reports, and Needs and Services plans. LPA observed that resident Physician's Reports will need to be updated to compliance. Administrator has began process to obtain updated documents for residents in care. Based on observations and review of records, a deficiency will be cited per Title 22, California Code of Regulations to address documentation. An exit interview was conducted, this report was reviewed, discussed and provided to Facility Representative.the state’s words, verbatim · CDSS document, Feb 13, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.