California Lifestyles IV

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to California Lifestyles IV. The purpose of today’s visit was to continue the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. During the visit, LPA reviewed staff training and medication administration. LPA observed required training for three staff. Three out of three staff files reviewed are missing 2 hours of training. Licensee to conduct training for remaining 2 hours. Medications are stored in a locked cabinet and appear to be administered per physician order. Licensee to forward LIC 308 designating a back up administrator by April 23, 2026. Based on the observations made during today's visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was given at time of visit.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to California Lifestyles IV. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the facility currently has 4 residents. There is 1 resident on hospice during today's visit. Administrator/ Licensee Roy Moeller arrived during the visit. LPA Lyman along with Caregiver Gapasin toured the facility at 1:48 PM. LPA toured the physical plant, checked food service, reviewed records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, four resident bathrooms, one staff room, one shared hall bathroom, living room, dining room, and 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 106.8 and 112.4 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked and self latching. LPA observed ample emergency food and water supply. Facility provides activities in the form of games and exercise. LPA reviewed four resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed contained required documentation such as health screen/TB, and criminal record clearance. All staff reviewed have CPR training. LPA to return at a later date to review medications and staff training. Licensee to forward a copy of liability insurance and updated LIC 500 to LPA by close of business 04/03/2026. Based on the observations made during today's visit, no deficiencies are being cited. Exit interview conducted and a copy of this report was given at time of visit.the state’s words, verbatim · CDSS document, Apr 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to California Lifestyles IV. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents. There are 3 residents on hospice during today's visit. Administrator/ Licensee Roy Moeller arrived during the visit. LPA Lyman along with Administrator Moeller toured the facility at 8:05 AM. LPA toured the physical plant, checked food service, reviewed records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, four resident bathrooms, one staff room, one shared hall bathroom, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed one resident with half bed rails and two with full rails. 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 108.9 and 114 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked and self latching. CONT ON LIC 9099C DATED 04/14/2025 LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 01/22/2025. Facility provides activities in the form of games and exercise. At 9:30 AM, LPA reviewed five resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed contained required documentation of annual training, health screen/TB, and criminal record clearance. At 10:00 AM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly by staff. Based on the observations made during today’s visit, deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy of this report along with appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Apr 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to California Lifestyles IV. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and met with Administrator Roy Moeller. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 2 residents and the home currently has 6 residents. There are 2 residents on hospice during today's visit. LPA Lyman along with Administrator Moeller toured the facility at 8:45 AM. LPA toured the physical plant, checked food service, and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, four resident bathrooms, one staff room, one shared hall bathroom, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with a half bed rails. 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 104.7 and 109 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. During today's visit, auditory door alarms are operational. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 01/18/2024. Facility provides activities in the form of games and exercise. CONT ON LIC 9099C DATED 04/12/2024. At 9:30 AM, LPA reviewed six resident files and two staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals. Staff files reviewed contained required documentation of annual training, health screen/TB, and criminal record clearance. At 10:15 AM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly by staff. Medications are being administered per physician order. Based on the observations made during today's visit, no deficiencies are being cited. Exit interview conducted and a copy of this report was given at time of visit.the state’s words, verbatim · CDSS document, Apr 12, 2024