Ashley House

Type of visit: Required - 1 Year

At approximately 1:10 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by back up Administrator Guadalupe Rivera. Ashley House is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, two (2) of whom may be bedridden. The facility has a Hospice Waiver for one (1) resident. Upon arrival, LPA was informed that there were zero (0) residents in care. The facility has not had residents since it's license was granted. At approximately 1:30 PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 1:35 PM, LPA toured the facility with back up Administrator Rivera. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged on 4/6/2026. The facility was sufficiently lighted. LPA inspected four (4) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored so as to be inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility will be conducting fire and emergency drills quarterly once residents are admitted. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. LPA was informed that once residents are admitted to the facility there will be a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Additionally, the facility will purchase emergency food and supplies to meet the "72 hour shelter in place" requirements. Continued on 809-C... ...Continued from 809 At approximately 2:10 PM, LPA reviewed two (2) staff files. Two (2) of two (2) staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA observed a locked cabinet with individual bins for resident's medications. The facility will not handle resident’s monies for personal and incidental items. Christine Woltering's Administrator Certification 7009993740 is current with an expiration date of 2/24/2027. Guadalupe Rivera's Administrator Certification 7004269740 is current with an expiration date of 4/1/2028. LPA requested the following documents be submitted to Community Care Licensing by 7/20/2026: LIC 500 Personnel Report LIC 308 Designation of Responsibility LPA has requested to be notified once residents have been admitted to the facility. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to back up Administrator Rivera. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 26, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 12:15 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by back up Administrator Guadalupe Rivera. Ashley House is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, two (2) of whom may be bedridden. The facility has a Hospice Waiver for one (1) resident. Upon arrival, LPA was informed that there were zero (0) residents in care. The facility has not had residents since it's license was granted. At approximately 12:25 PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 12:30 PM, LPA toured the facility with Administrator Rivera. All exits were clear and unobstructed. The facility's one (1) fire extinguishers was last serviced and tagged on 4/4/2024. As the facility does not have any residents a Technical Advisory will be issued. The facility was sufficiently lighted. LPA inspected four (4) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility will be conducting fire and emergency drills quarterly if residents are admitted. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 12:50 PM, LPA reviewed one (1) staff files. The staff file was observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA observed a locked cabinet with individual bins for resident's medications. The facility will not handle resident’s monies for personal and incidental items. Guadalupe Rivera’s Administrator Certification 7004269740 is current with an expiration date of 4/1/2026. LPA requested the following documents be submitted to Community Care Licensing by 8/21/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance No deficiencies cited during today's visit. Exit interview conducted. Copy of report and LIC 9102 discussed and provided to Administrator Rivera. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 7, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

At approximately 8:45AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Change of Location Pre-Licensing Visit and met with Licensee/Administrator, Christine Woltering. Facility serves older adults and has a plan of operation for dementia care and programming on file. Facility received an approved fire clearance on 08/09/2024, which states that facility has a total capacity for 6 non-ambulatory residents of which 2 residents can be bedridden. Facility has an approved hospice waiver for 1 individual. Upon arrival, LPA was informed that there were 2 Residents in care. At approximately 8:50AM, LPA conducted a walk-though of the facility with Licensee. LPA observed the following: Facility is a one story building with 4 bedrooms, 2 1/2 bathrooms, and common spaces. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for all sinks were found to be within Title 22 Regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguishers were last inspected April 2024. Smoke and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid Kit were sufficient. Per Licensee, there are no changes to facility's plan of operation or program with the change of location. No Deficiencies or Advisories given during visit. Pre-Licensing completed. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted. Copy of report discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 20, 2024