Assisted Living & Wellness - Holly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA Vaid met Kristina Brown who allowed entry into facility. LVN, Margaret Grancich was notified and arrived shortly after to assist with the visit. The facility is licensed to serve six (6) non-ambulatory residents, ages 60 and above, of which one (1) may be bedridden. Bedroom#6 is approved for bedridden. The facility has an approved Hospice Waiver (for six (6) residents) and a Dementia Care program. Administrator certificate is pending, and the expiration date is 07/22/2025. During the visit, the CARE tool was used, staff /residents were interviewed, staff/residents’ records were reviewed, physical plant was conducted, food supply was reviewed, and medications were reviewed. The facility is a single-family residence located in a neighborhood, consisting of six (6) bedrooms, three (3) full bathrooms, 1 half bath (only has a toilet and a sink), kitchen, dining room, sunroom, den, nook, laundry room, office, and living room with a TV. No pools and bodies of water on the premises. All the rooms were furnished with appropriate furniture for residents’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was measured at 108.2, 106.9, 107.9 and 114.6 degrees Fahrenheit for 4 bathrooms which were within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Auditory alarm devices to monitor exits were operable. Sufficient supply of perishable and nonperishable foods is observed. Smoke and carbon monoxide detectors are dual/hardwired and operable. Fire extinguishers’ last service is 02/03/2025 and are fully charged. Medication is centrally stored in a locked cabinet and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents. Continued on 809C............... Outdoor facility space used for residents and leisure are completely enclosed by a fence with self-closing gates. Posted Liability Insurance expired 10/22/2025. Residents files and staff files were observed and are completed. Medications is stored in locked cabinet and are inaccessible to the residents. Staff and residents files were observed and are inaccessible to residents. Cleaning products are locked and inaccessible to residents. No deficiencies were observed during the facility inspection. An exit interview was conducted. This report was discussed and provided to Margaret Grancich, LVN.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Martha Ramirez, caregiver for the facility, and explained the purpose of the visit. Administrator Jennifer arrived shortly thereafter. There are six (6) residents residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices were observed. · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, six (6) of which may be non-ambulatory, one (1) of which may be bedridden, and a hospice waiver approved for six (6) residents. The facility consists of a kitchen, a dining room, a living room, a sun room, six (6) resident bedrooms, four (4) bathrooms which all measured within the required range of 105 – 120 Degrees Fahrenheit, along with a backyard that contains a shaded area. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has two (2) fully charged fire extinguishers in the facility. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of six (6) residents, six (6) of which may be non-ambulatory, one (1) of which may be bedridden, and a hospice waiver approved for six (6) residents. · Care and supervision to meet the clients’ needs was observed. Staffing: · Nineteen (19) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All Five (5) staff records reviewed have a health screening with a Tuberculosis clearance, and five (5) staff have First Aid/CPR trainings that are active. · The administrator’s certificate expires on 7/22/2025. Resident Rights/Information: · Physician orders were reviewed for six (6) resident files. · Medications were also reviewed for six (6) residents. Resident Records/Incident Reports: · Six (6) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was found in the facility. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs: · Four (4) residents are receiving hospice services. · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with administrator Kenneth and consultant Vanessa whose assisted with visit. The facility is licensed to serve six (6) non-ambulatory residents, ages 60 and above, of which one (1) may be bedridden. Bedroom#6 is approved for bedridden. The facility has an approved Hospice Waiver (for six (6) residents) and a Dementia Care program. Administrator certificate is current and the expiration date is 11/24/24. Annual fees are current. During the visit, the CARE tool was used, staff /residents were interviewed, staff/residents records were reviewed, physical plant was conducted, food supply was reviewed, and medications were reviewed. The facility is a single-family residence located in a neighborhood, consisting of six (6) bedrooms, three (3) full bathrooms, 1 quarter bathroom (only has a toilet and a sink), kitchen, dining room, sun room, den, nook, laundry room, office, and living room with a TV. No pools and bodies of water on the premises. All the rooms were furnished with appropriate furniture for residents’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was 114.6 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. Auditory alarm devices to monitor exits were operable. Sufficient supply of perishable and nonperishable foods is observed. Smoke and carbon monoxide detectors are dual/hardwired and operable. Fire extinguishers’ last service is 3/23/23 and are fully charged. Medication is centrally stored in a locked cabinet and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents. Outdoor facility space used for residents and leisure are completely enclosed by a fence with self-closing gates. No deficiencies were observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed and provided to Administrator.the state’s words, verbatim · CDSS document, Feb 20, 2024