Bert Lilleen Care Home

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Contreras arrived unannounced to complete required annual inspection and was greeted by licensee Lilia Saddi. LPA reviewed 3 of 3 resident records. Needs and Service Plan were missing for R2 and R3. In addition, R3 was missing signed Medical Consent (LIC627C) Form and Personal Rights (LIC613C) Form (Deficiency Cited, see LIC809D) LPA reviewed 3 staff records. All required documentation was present. LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored and Centrally Stored Log up to date. Facility does not handle P&I monies for residents. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and report given to Licensee.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection and was greeted by licensee Lilia Saddi. Facility is a Residential Care Facility for the Elderly that has a fire clearance approved for six residents in which four can be ambulatory and two non-ambulatory. Approved hospice waiver for two residents. Upon arrival, LPA observed staff (S1) was fingerprint cleared but was not associated to Guardian Roster (Deficiency cited, see 809D) LPA and admin toured the building and grounds which was found to be clean and in good repair. Facility was clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 2/03/2025. Fire alarms and carbon monoxide detector were tested and operational. Outdoor emergency exit clear from obstruction. Signal system and alarms throughout facility were functional. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. During inspection, facility was in process of replacing new refrigerator. While food was being taken out of previous refrigerator, LPA observed various frozen meats and foods to not have expiration dates noted. In addition, LPA observed multiple canned items to be expired (Technical Violation given). LPA observed medication including chest congestion medicine and Delsym to not be properly stored and accessible to residents on top of kitchen counter sink. Opened box of expired medications observed to be in garage not centrally stored or locked (Deficiency cited, see 809D). Continued to 809-C.... continued from 809C... LPA observed medication to be pre-poured for the following medication pass. LPA had conversation with admin that medication cannot be pre-poured from its original container(Technical Violation given). All bedrooms were equipped with lighting, a night stand and chest of drawers. All bedrooms were clean and in good repair. LPA observed cameras in resident master bedroom and resident room 3. Licensee stated cameras in room 3 were requested by the resident family but was not able to provide documentation. Master bedroom camera was placed by licensee. Licensee was not able to provide documentation but stated resident gave verbal permission. Licensee stated cameras have audio and video recording. LPA had conversation with licensee that cameras and audio recording cannot be placed in private areas (Deficiency cited, see 809D). Facility had an ample supply of linens, towels and extra hygiene products for residents. Resident bathroom had required bath mat and grab bar. Water temperature measured at 111.1 degrees F at faucets accessible to residents which is within the allowable range of 105 to 120 degrees F. LPA will return at another date to complete annual. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and report given to Licensee.the state’s words, verbatim · CDSS document, Nov 13, 2025

Type of visit: Case Management - Annual Continuation

At approximately 9:45 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a case management -- annual continuation visit to review resident files, staff files, medications, and medication logs, and met with Lilia Saddi, Licensee. At approximately 10:15 AM, LPA conducted file review. Four (4) staff and two (2) resident files were reviewed and LPA observed the following: Four (4) staff files were observed to have the required documentation per Title 22 regulations. However, LPA observed 3 of 4 staff files missing valid proof of completed required training, and 1 of 4 staff files were observed missing valid proof of the required first aid certification, (see LIC809Ds). LPA reviewed two (2) of two (2) resident files which were each observed to contain the required documents per regulation. However, LPA observed one (1) resident's file missing proof of negative TB results, (see, LIC809D). Licensee states that the facility and residents' family members coordinate residents' medical and dental appointments and transportation to and from visits. Medications and medication records were inspected and observed maintained in compliance with regulation. However, LPA advised Licensee on best practices for ensuring the medication logs accurately reflect medication start dates. Licensee conveyed understanding and agreed to bring the facility into compliance. Facility does not handle P&I. 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, or repeat violations within a 12 month period, may result in a civil penalty assessment. Exit interview conducted with Licensee, whose signature on form confirms receipt of documents. Appeal rights provided.the state’s words, verbatim · CDSS document, Mar 20, 2025

The state marks this report as 4 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 2:30 PM, Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and were greeted by facility Staff. Licensee was contacted via telephone and arrived at approximately 2:45 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for 2 non-ambulatory residents. Facility currently has two residents on Hospice. At approximately 3:00 PM, 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. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens, and 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 observed unlocked in two instances. Licensee removed the items immediately and secured them in the locked laundry room. Licensee agrees to ensure all items which could pose a risk to residents in care are secured at all times to remain compliance with regulation. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPAs observed an activity schedule and books, puzzles, and movies for residents. Facility does not have an internet access device designated for resident use, but Licensee agrees to purchase one immediately. Facility has internet service available to residents in care and the telephone was tested an operational during inspection. Facility's fire extinguisher was observed charged and was last serviced 02/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts quarterly disaster drills, and the most recent drill was conducted 01/2025. Continued on LIC809-C... Continued from LIC809C... LPAs observed the facility's infection control plan, several first aid kits, PPE, and emergency supplies. LPAs reviewed facility's emergency disaster plan last updated 01/2025. Licensee stated they would like to change the Administrator. LPA discussed what needs to be submitted to CCL for this change. LPAs will return at a later date to complete the annual inspection. LPAs will review resident files, staff files, and medications and medication logs during that visit. Facility does not manage P&I. Required Change of Administrator Documents: LIC 308 (Designation of Facility Responsibility) Active and Current Administrator Certificate First Aid Certificate LIC 500 (Personnel Report) LIC 501 (Personnel Record) LIC 503 (Health Screening Report - personnel) Proof of Negative TB test LIC 9182 (Criminal Record Exemption Transfer Request) LIC 508 (Criminal Record Statement) Copy of Driver's License or Passport that is not expired Statement signed by Licensee requesting Change of Administrator Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500 - Personnel Report (updated) Copy of New Liability Insurance Policy No deficiencies were cited during inspection. Exit interview conducted with Licensee whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jan 30, 2025

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

On 1-25-24 Licensing Program Analyst LPA Sarah Benson met with Jenny Saddi acting administrator to make corrections to annual performed on 1-24-24. The CARES tool did not populate the 809-D page, (a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: (1) Socialization, achieved through activities such as group discussion and conversation, recreation, arts, crafts, music, and care of pets.the state’s words, verbatim · CDSS document, Jan 25, 2024

Type of visit: Required - 1 Year

On 01/24/2024 10:30 AM Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Jenny Saddi (cert #6014581740 exp.05-22-2024) and explained the purpose of the visit. Administrator certificate is current. LPA Benson and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to four (4) resident rooms, (1) one staff room, (1) one staff bath room, common areas, two (2) bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medications were also reviewed. Medication is locked in a locked closet. The common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. All required postings are displayed within facility. No pools/bodies of water are on the premises. No firearms are on premises. There is not a schedule of activities Planned for the clients. The following deficiencies were observed (See LIC 809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and copy of report was provided to administrator with appeal rights.the state’s words, verbatim · CDSS document, Jan 24, 2024