Arlyn's Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility on 2/6/2026 at 9:45 am to conduct an annual inspection. LPA met with administrator Arlyn De La Cruz and explained the purpose of the visit. 2 clients have restricted conditions, both are diabetic one has additionally O2 administration. Arlyns guest home is an RCFE for the elderly/developmentaly disabled + dementia with a capacity of 6 nonambulatory and 2 hospice and a current census of 3 nonamb, 0 hospice. Exception paperwork will be filled out for the O2 administration. Physical inspection included but was not limited to: Kitchen,bedrooms, bathrooms, common areas, storage areas, the exteriors, and the evacuation route. facility is clean, traffic areas are unobstructed and well lit. Kitchen has food storage for 2 days perishable and 7 days non perishable for 3 clients. LPA gave guidance to put "Staff" of staff foods. there is lockable storage for the medication, Per administrator, VMRC has said not to lock the cleaning matierials and knives. LPA gave guideance that knives and cleadning chemicals should be in lockable storage when outside of supervised use. Bedrooms have required furniture and furnishings, including materess encasements, there exists duplicate linens. bathrooms have functional hardware, common areas and exteriors are free of trip hazzards and furnishings are in good repair, evacuation route gate swings freely and latches closed, on one side on the building. a secondary gate does drag into the concrete. LPA gave guidance to monitor the situation. Continued on c Page. Fire extinguisher was dated 12/12/25, Smoke/Co alarm was functional, water temperature was measured at 105-120*F. Medication was checked against mars for 2 clients at random, found to be in agreement. LPA pointed out there are too many drugs for one of the clients, per administrator the excess will be destroyed and marked in the destruction record. LPA gave guidance that medication with variable dosage should not be given without a documented consultation from a licensed medical professional every time, and it would be improper for her as the licensee to make medical choices regarding the clients care, since she has a buisness interest in particular outcomes. Client files were reviewed including but not limited to: recent medical assessments, signed admission agreements, needs and servess plans, functional assessments and IPPs. documents are up to date and present. P+I was checked against balance statement for 1 clients, found to beholding cash over the balance sheet by about 50 cents. LPA gave guidance it should be tracked accurately. Staff files were reviewed including but not limited to: health screenings, initial and continued trainings, first aid training, and backround check clearances with the doj and fbi, were found to be present and up to date. LPA gave guidance that annual training topics should lean on developmentally disabled clients needs, and diabetic care. LPA gave guidance Any clients unplanned visit to the hospital/acute psychiatric should be reported to ccl within 7 days of the occurrence using the LIC 624 form. Administrator files were reviewed, including but not limited to: facility posters(ombudsman, client rights, family council, resident council, emergency/abuse services contacts, facility sketch with evacuation route, facility license, federal work rights, and administrators license()expires 11/23/25) are all in the staff room. Per administrator VMRC asked for posters to not be in the living space of the facility, LPA gave guidance that at least the ombudsman, client rights, emergency and abuse services contacts, and facility sketch with evacuation rout should be posted near the door. control of property, liability insurance, surety bond, were found to be present and up to date. administrators hiv training, infection control plan, evacuation plan, workers comp, should be emailed to the LPA. Gaurdian roster should be cleaned out at least once a year, but ideally when people come on or leave the company. noel.wolfpetersen@dss.ca.gov 3 interviews with clients, 1 interview with staff. A copy of the report was read and given to the administrator, an exit interview was conducted.the state’s words, verbatim · CDSS document, Feb 6, 2026

Type of visit: Required - 1 Year

On 1/18/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Facility Designated Administrator (FDA), Arlyn De La Cruz and explained the purpose of the visit. The purpose of this visit was to conduct an annual visit. It was learned that this facility is undergoing changes to obtaining Regional Center Services to expect and retain Level 4I elderly residents. This facility currently has no residents in care. This facility was formerly an RCFE that served and retained 6 elderly residents. The facility residents were served proper notices and were relocated to different licensed facility. Current census was 0. A brief interview with FDA De La Cruz. FDA De La Cruz has current administrator certificate The administrator has a current administrator certificate #7001834740 and expires on 11/23/2025. A tour of the facility was conducted. Smoke detectors and carbon monoxide detectors were observed to be in good compliance at this time. Fire extinguisher was serviced by a local fire company 12/13/2024. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time. Medication cabinet, located in the kitchen area, was toured. First aid kit was observed to be present and contained all required components at this time. A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of the resident bathrooms was conducted. Tour of 2 staff bedrooms were also conducted. Hot water temperatures were taken and measured within the allowed range of 105-120 degrees. Linen closet was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time with no hazards present. Garage area was toured. A washer and dryer was identified. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610e -Updated Fire Clearance and facility sketch -A copy of the facilities new program design. No deficiencies were observed or cited during this annual visit. A copy of this report was given to Facility Designated Administrator. Exit interview.the state’s words, verbatim · CDSS document, Jan 18, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced case management visit deficiency visit. LPA met with direct care staff and explained purpose of visit. LPA cleared plan of correction (POC) on 1/9/2024 for fire and earthquake drills not being conducted every three months. The facility conducted fire/disaster drills with residents on 7/8/2023, there not in compliance. It was a repeated violation within twelve months, so facility received a civil penalty on 1/8/2024. LPA used the wrong regulation out of adult residential instead of senior regulations. Today's visit clears the POC and no further action is required by licensee. Exit interview held with direct care staff. A copy of report was left at facility.the state’s words, verbatim · CDSS document, Feb 6, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with administrator and explained purpose of visit. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, client bedrooms; client bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in client's bathroom at 111.7 degrees Fahrenheit which is within the required range of 105 to 120 degrees. Fire extinguishers last inspected on 12/19/2023. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to clients. LPA reviewed and compared client medication vs. medication logs. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. The facility conducted fire/disaster drills with residents on 7/8/2023. Fire and earthquake drills shall be conducted every three months, so facility was not in compliance. LPA reviewed four resident files and four staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following deficiency was observed (see LIC 809-D) and cited from the Health and Safety Code and the California Code of Regulations, Title 22. Failure to correct the deficiency may result in additional civil penalties. Exit interview held with administrator. A copy of reports, appeal rights, and LIC 811 (Confidential Names) were left at facility.the state’s words, verbatim · CDSS document, Jan 8, 2024