Bayside Cottages III

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 14 non-ambulatory residents. Facility has an approved hospice waiver for 14 residents and the home currently has eight residents, with four residents on hospice. Administrator (AD) Benjie Dizon arrived shortly to conduct facility tour. AD provided updated liability insurance that expires on 2/26/2026. LPA along with AD toured the facility at 12:30 PM. LPA toured the physical plant, checked food service, and facility documentation. The facility is a one story house with an attached garage with 7 resident bedrooms, 3 full bathrooms, 1 half restroom, a living room, a dining room, and a kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 110.1 degrees F and 120.2 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 1/09/2026. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPA observed the emergency food and water supply. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise. LPA reviewed five resident files and four staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Medications are being administered per physician order. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Ruth Martinez and Hanna Gough conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at facility was greeted and granted entry. LPA met with Benjie Dizon, applicant. An initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (14) capacity, (0) ambulatory, (14) non-ambulatory, and (0) bedridden resident was submitted to CCL on 04/24/24. Structure: The facility is a one story house with an attached garage with 7 resident bedrooms, 3 full bathrooms, 1 half restroom, a living room, a dining room, a kitchen. The resident’s bedrooms are spacious and will easily accommodate the resident’s furnishings. There is shaded seating areas in the backyard for resident and an exit walkway on each side of the house. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 14 residents with 7 bedrooms being shared. Bedrooms #6 & 7 have their own bathroom. Bedrooms Staff: No staff designated bedroom.Bathrooms: Facility has 4 full bathrooms and 1 half restroom. All bathrooms have a working toilet, wash basin, walk in shower. Linens & Hygiene Supplies: Adequate supply of linen in storage. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables will be stored in the kitchen. Additional food storage in garage in spare refrigerator Continued on LIC809-C and a freezer and a pantry located in garage. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested, and found operational. 2 fire extinguishers mounted in bedroom hallways, charged, and dated April 10, 2024, there is 1 fire extinguisher mounted in the garage charged with service date of June 20, 2024. Smoke detectors are maintained and serviced through a vendor called Alarm Central. Appliances: There is 2 Gas 5 burner stoves, 3 ovens, 3 refrigerators (kitchen/garage), a freezer, microwave, dishwasher, washers, and dryers are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents are stored and locked underneath kitchen sink and in the garage. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 108.3 Fahrenheit degrees in facility bathrooms. Medications, First-Aid Kit & Book: Medication will be stored in a locked storage closet located in hallway. First Aid kit stored with medication and book is stored with files. Resident & Staff Files: Records will be kept locked in storage cabinets located in the dining room. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the resident's use, commensurate with the plan of operation. Fire clearance: Was approved on June 26, 2024. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Jan 15, 2025