Beech Grove Care Home

Type of visit: Required - 1 Year

At approximately 12:30 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Administrator Sarah Jane Bautista arrived at 1:10 PM. Beech Grove Care Home 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. The facility has a Hospice Waiver for six (6) residents. Upon arrival, LPA was informed that there were six (6) residents in care and two (2) staff members on-site. At approximately 12:45 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 12:55 PM, LPA toured the facility. All exits were clear and unobstructed. The facility's (2) fire extinguishers were last serviced and tagged on 4/20/2026. The facility was sufficiently lighted. LPA inspected six (6) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by 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 is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 4/4/2026. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. 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 observed to be operational. Continued on 809-C,,, ...Continued from 809 At approximately 1:40 PM, LPA reviewed five (5) resident files. Five (5) of five (5) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed four (4) staff files. Four (4) of four (4) staff files were observed to be well organized with all required documentation including First Aid and CPR certification and proper training documentation. LPA audited Medication for three (3) residents. During the inspection, LPA observed a prescribed medication for resident R1 to be unsecured. The medication was observed in the kitchen drawer to the immediate left of the refrigerator. The facility will be cited for this deficiency. LPA observed all other medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Sarah Jane Bautista’s Administrator Certification 7037231740 is current with an expiration date of 4/23/2028. LPA requested the following documents be submitted to Community Care Licensing by 6/12/2026: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Bautista. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 12, 2026

Type of visit: Required - 1 Year

At approximately 09:15 am, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by caregiver Maria Delfino Facility is a Residential Care Facility for the Elderly (RCFE) licensed for 6 residents with five (5) residents in care. Facility has a Hospice waiver for six (6), with 2 hospice residents currently in care, and is approved for all non-ambulatory residents. At approximately 09:45 AM administrator Sarah Jane Bautista arrived. At approximately 09:45 am, LPAs initiated a tour of the facility with licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 05/2024 and were observed to be fully charged . Water temperatures measured 115.5F and 116.5F. LPAs observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. A strong odor of urine was detected inside and just outside bedroom #5 with patient noted to have a history of incontinence and hospice care (deficiency cited) LPAs observed at least a 2-day supply of a variety of healthy perishable foods, 7-day supply of non-perishable food, and emergency water supplies. In addition, a variety of snacks and fruits were observed to be set out for residents. Food was found to be stored in a safe manner with open items covered. Continued 809C... Continued from 809... Facility has both a backup battery wall and generator, LPA observed a piano, TVs, books, patio with ramps, seating and sunshade accessible to residents. Licensee was advised to ensure that tall green grasses were cut to reduce fire hazard as grasses dry out. Disaster drills were last conducted 12/04/2024, At approximately 11:15 AM LPA conducted a review of five (5) staff records. All 5 staff had required criminal clearance, health records and educational training. At approximately 11:45 AM LPA conducted review of five (5) resident records. All required documentation was present. At approximately 12:00 PM LPA and Licensee Bautista conducted a spot check of medication and medication records with records observed to be accurately kept. Medications were observed to be centrally stored and locked. A copy of current liability insurance was obtained Licensee/Administrator to submit updates of the following documents by 05/02/2025 LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan - updated (if needed) and signed and dated LIC 308 Designation of facility responsibility. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Licensee/Administrator Sarah Bautista and Appeal rights were given.the state’s words, verbatim · CDSS document, Apr 2, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Pre-Licensing Inspection and met with Applicant/Administrator, Sarah Jane Bautista. Applicant has applied for a Change of Ownership at this location and currently has 6 residents in care. Facility is a one story residence with six resident bedrooms, 3 bathrooms, living room, dining room, kitchen area, one staff/office room and the garage. All resident rooms have the required furnishings in bedrooms. Bathroom showers have non-skid shower floors/mats and grab bars. Water temperature in bathrooms is within regulation of 105 & 120 degrees F. Facility has sufficient items used for cooking and eating. The refrigerator was observed to be clean and there was plenty of perishable and Non perishable foods that appeared in good condition and stored properly. There was an additional refrigerator and freezer and extra canned goods in the garage. Cleaning supplies are locked under kitchen sink and locked. Sharps are located in kitchen drawer and locked. Personnel records and resident records are stored in locked cabinet. Medication is centrally stored and locked. Facility received an approved fire clearance dated February, 2024 that allows for 6 non-ambulatory residents. Carbon monoxide and smoke alarms are operational. Fire extinguishers are charged and serviced 5/7/2024. Required postings were observed. Auditory alarms on doors were operational. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation. Component III was conducted today, with Applicant, Sarah Jane Bautista, Administrator . Pre-Licensing is complete. No citations issued.the state’s words, verbatim · CDSS document, May 24, 2024