Anna's Park Haven

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Tremayne Barra made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with administrator, Anna Estaniel. The LPA informed the Administrator of the purpose for the visit. There was 6 (six) resident and 3 (three) staff present at the time of the inspection. The inspection included the following: LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured within requirements. Laundry facilities have locked cabinets present for storing laundry soap and other chemicals in the designated laundry room outdoors. All outdoor and indoor passageways are free of obstruction. LPA verified there is a telephone working at this location. Pool was observed with a locked gate and a fence above 5 feet. LPA observed the facility kitchen. Kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. LPA conducted review of employee records. Four (4) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPA began review of client records. Four (4) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, TB test results, needs and service plans, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be available and complete. Medications are centrally stored. There is a locked cabinet in the family room allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers was last serviced on 02/04/2026. Fire drills are conducted quarterly at the facility with the last drill on 03/02/2026. Based on the information received during this visit today in the areas reviewed, there are no deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809 report was reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Mar 30, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conclude the annual inspection that was began on 2/21/2025. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose. Administrator stated two (2) residents are currently at SNIF. Employee records review began- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 112.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the designated laundry room outdoors. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued from Page 1) LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure has been changed and it not according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguisher was tested on 01/24/2024 which is expired. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 01/3/2025. Based on the information received during this visit today, there are five (5) deficiencies being cited with Civil Penalties of $500 being issued per Title 22, Division 6 of The California Code of Regulations. This report, LIC809D, Appeals Rights was reviewed with Anna Estaniel and a copy provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Three (3) records were reviewed. LPA reviewed for admission agreement, medical assessment-1 expired and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records-1 missing, safeguard for personal property/valuables, and personal rights notification. This facility is not meeting documentation requirements. Due to time constraints, LPA will need to return to complete the annual inspection. The following domains were completed: Res-Rec Incidental Reports, Incidental M&D, Resident SHN. Based on the information received during this visit today, there are two (2) deficiencies is being cited per Title 22, Division 6 of The California Code of Regulations. This report, LIC809D and Appeal Rights was reviewed with and a copy provided to the facility representative at the time of the exit interview.the state’s words, verbatim · CDSS document, Feb 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to complete a required annual inspection. The LPA met with Administrator, Anna Estaniel, and informed her of the purpose for her visit. Physical Plant: The facility consists of four (4) resident bedrooms, one staff bedroom, one dining area, two living spaces, a kitchen, a laundry area, a garage space, and a covered patio with sufficient seating and space for activities. The facility's pool was observed to be inaccessible to unauthorized individuals. According to Administrator Estaniel, there are no weapons stored in the home. The facility is being maintained at a comfortable temperature. All indoor areas were observed to be free of debris and other trash. There are grab bars for the toilet and shower used by residents. Resident shower has a non-skid mat present. The carbon monoxide and smoke detectors were tested by facility staff and were observed to be in operating condition. LPA observed about three chemicals/cleaners to be accessible in restroom #2. A citation will be issued. Medication Review: A medication review was completed for Resident Three's (R3's) medications. Medications were maintained separate from other resident's medications. Staff Records: The LPA reviewed staff training and observed first aid and CPR training to be available. Resident Records: The LPA reviewed resident records. A Pre-Admission Appraisal and Admission Agreement was observed on file for R3. A written record of care was not observed on file for R3. When reviewing resident hospice files the LPA observed no hospice care plan for Resident One (R1). Citations will be issued. An exit interview was conducted; this report was reviewed with Administrator Estaniel and a copy was provided, along with instructions on appeal rights, and the LIC 811.the state’s words, verbatim · CDSS document, Mar 28, 2024