Canton Cottage

Type of visit: Required - 1 Year

On July 7, 2026, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met administrators Edgar Yraheta and Jose Umana and explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory, of which (1) may be bedridden elderly adults ages 60 and above. Currently, the facility has (1) hospice resident in care. The facility is approved for (6) hospice residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: (4) residents' rooms, (2) bathrooms, a living area, a dining area, a kitchen, an outside seating area, and a garage utilized for storage. LPA toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 107.9 degrees F. A comfortable temperature of 71 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were charged. A review of the Medication Administration Records (MAR) was observed to be maintained in order and complete. (Evaluation Report continues LIC 809-C) All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on May 15, 2026 at 3 PM. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance with policy #PC193091533-02 effective 02/01/2026 through 02/01/2027. An audit of resident #1-#6 (R1-R6) service files and staff #1-#4 (S1-S4) personnel files. The facility has the current administrator's certification for Edgar Yraheta #6082075740 valid through 05/21/2028 and Jose Umana #7001004740 valid through 07/05/2027. The facility is not current on (CCL) annual dues. No Deficiencies Advisory Notes - Technical Violation (see LIC 9102) An exit interview was conducted with Edgar Yraheta, the Administrator, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Case Management - Annual Continuation

On 06/13/25, Licensing Program Analyst (LPA) Deborah Lee conducted a Case Management-Annual Continuation visit using the CARE Inspection Tool to continual annual started on 5/15/2025. LPA was met by Edgar Yraheta, Administrator Assistant, and the purpose of today's visit was explained. The facility is licensed to operate for 6 non-ambulatory, of which (1) may be bedridden, elderly adults ages 60 and above. Currently, the facility has 6 residents in care. The facility is approved for (2) hospice residents. Physical Plant/Structure: The facility is a single-story structure located in a residential neighborhood. It consists of the following: (4) residents' rooms, (2) bathrooms, a living area, a dining area, a kitchen, an outside seating area, and a garage utilized for storage. The facility is a one story residential home consists of 6 resident bedrooms, (2) resident bathrooms, living rooms, dining room, kitchen, staff room, office area, storage area, attached garage washer and dryer room, backyard with table and chairs. LPA Lee and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. File Review: LPA reviewed 4 resident files and found that ( 4 ) out of ( 4) had the required documents. LPA reviewed 4 staff files and found that ( 4 ) out ( 4 ) had the required documents, training, and certifications. Page 1 of 2 Medications LPA observed all centrally stored medications secured All medications were observed in their original packaging. LPA reviewed a copy of the facility’s Liability Insurance with expiration date of 02/1/26 Infection Control LPA observed required infection control signs posted throughout the facility. LPA observed a sanitizing stations in entryway of facility. No citations issue during todays visit Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jun 13, 2025

Type of visit: Required - 1 Year

On 05/15/25, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA was met by Edgar Yraheta, Administrator Assistant, and the purpose of today's visit was explained. The facility is licensed to operate for 6 non-ambulatory, of which (1) may be bedridden, elderly adults ages 60 and above. Currently, the facility has 6 residents in care. The facility is approved for (2) hospice residents. Physical Plant/Structure: The facility is a single-story structure located in a residential neighborhood. It consists of the following: (4) residents' rooms, (2) bathrooms, a living area, a dining area, a kitchen, an outside seating area, and a garage utilized for storage. The facility is a one story residential home consists of 6 resident bedrooms, (2) resident bathrooms, living rooms, dining room, kitchen, staff room, office area, storage area, attached garage washer and dryer room, backyard with table and chairs. LPA Lee and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. Bedrooms: LPA inspected all 4 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Page 1 of 2 Bathrooms: Toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature, and it measured between 105 and 120 degrees Fahrenheit. There was adequate supply of linens available for the residents. Common Rooms: All common areas are clean and free of obstructions. There is adequate seating for the residents in care. Each common area is equipped with furniture that is in good repair. Required Postings: LPA observed all required documents posted throughout the facility. The facility has a working landline telephone. Kitchen LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Sharps were locked away and inaccessible to the residents. Safety LPA observed 2 fully charged fire extinguishers last serviced on 5/12/2025. The last emergency drill was conducted on 1/17/25. Medications: LPA observed all centrally stored medications secured All medications were observed in their original packaging. Due to time restraint, LPA to continue inspection on subsequent visit. There were no citations issued during this visit. Exit interview conducted with Administrator Assistant Edgar Yraheta Page 2 of 2the state’s words, verbatim · CDSS document, May 15, 2025

Allegation investigated: Staff physically abused resident while in care.

On 04/17/202 at 9:55 a.m., Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit on to gather information regarding the above allegation. LPA met with Licensee/Administrator Jose Umana, and the purpose of the visit was explained. LPA was granted entry to the facility. Investigation consisted of the following: On 04/17/2025 at 9:50 a.m., the Department requested and reviewed the staff and resident's records and asked for copies of the following documents: Personnel Report (01/31/2025), Resident Roster (02/13/2025), Admission Agreement, Identification and Emergency Information, Physician's Report, Medical Assessment, Medication Administration Records (MARs), Consent Forms, Functional Capability Assessment, Preplacement Appraisal Information, Appraisal, Needs and Service Plan. Interviews were conducted with staff 1-2 (S1-S2) and resident 1-6 (R1-R6) all of whom denied the allegation. At 10:30 A.M., the department toured the facility buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit. See continued LIC9099-C page 2 Unfounded Continued LIC9099-C page 2 Allegation: Staff physically abused resident while in care. The investigation revealed the following: The investigation was initiated in response to an allegation that a staff member physically abused a resident while under the care of the facility. On April 17, 2025, the Department conducted interviews with staff members 1 and 2 (S1-S2) and residents 1 through 6 (R1-R6). All individuals interviewed stated that the alleged incident did not occur at Canton Cottage. They confirmed that no resident by the reported name resides at the facility, nor is there any staff member by that name employed at Canton Cottage, according to the resident roster, personnel and complaint reports. However, S1 stated that a resident and staff matching the names mentioned in the complaint are currently located at Servato Cottage, a different facility. S1 stated that it is likely the complaint was mistakenly filed against the wrong facility. A through review of the staff personnel records and resident roster at Canton Cottage confirmed that the individuals named in the complaint are not affiliated with this facility in any capacity. S1-S2 and R1-R6 reported that residents are treated with dignity and respect in their interactions with staff and other individuals within the facility. S1-S2 stated that residents are provided with safe, healthful, and comfortable accommodations, to meet their individual needs. S1-S2 stated that residents are free from corporal or unusual punishment, the infliction of pain, humiliation, intimidation, ridicule, coercion, threats, mental abuse, or any other punitive actions. This also includes protection from interference with daily living functions such as eating, sleeping, or toileting, as well as withholding shelter, clothing, medication, or aids to physical functioning. R1-R6 stated they feel safe, and happy, and that the staff is providing residents with the necessary care and supervision to meet their needs. See continued LIC9099-C page 3 Continued LIC9099-C page 3 This agency has investigated the complaint alleging Physical Abuse allegation. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to the Licensee/Administrator Jose Umana. There were no deficiencies cited. An exit interview was conductedthe state’s words, verbatim · CDSS document, Apr 17, 2025 · control 11-AS-20250416100930

Type of visit: Required - 1 Year

On 06/13/2024 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual required visit using the CARE Inspection Tool. LPA was met by Edgar Yraheta, Administrator Assistant, and the purpose of today's visit was explained. The facility is licensed to operate for (6) non-ambulatory, of which (1) may be bedridden, elderly adults ages 60 and above. Currently, the facility has five (5) residents and zero (0) hospice residents in care. The facility is approved for (2) hospice residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: (4) residents' rooms, (2) bathrooms, a living area, a dining area, a kitchen, an outside seating area, and a garage utilized for storage. LPA toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 117.2 degrees F. A comfortable temperature of 77.0 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were charged. A review of the Medication Records Administration (MAR) was observed to be maintained in order and complete. Report continues, see LIC809C. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 04/18/2024 and earthquake drill on 05/20/2024. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 02/01/24 through 02/01/25. There have been no deficiencies cited today. An exit interview was conducted with Edgar Yraheta, Administrator Assistant, and a copy of this report have been provided.the state’s words, verbatim · CDSS document, Jun 13, 2024