Casa De Los Arboles

Type of visit: Required - 1 Year

On April 24, 2026, at 8:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator Irvin Harris Mendoza and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory, of which one (1) may be bedridden and have a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, four (4) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Mendoza. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. LPA observed R1’s room and R2’s room both have a postural support attached to their bed. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 108.5 degrees F to 113.7 degrees F. A comfortable temperature of 73 degrees maintained in the facility. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Emergency food, emergency water, and emergency supplies are stored in the garage. A working telephone (714-602-8845) and an internet accessible device dedicated to the residents that can do video teleconference which both remain available. Last emergency drill was conducted on March 31, 2026. First aid kit is maintained and contains all the necessary elements. The facility has two (2) fire extinguishers which are located and mounted in the dining area and the resident hallway. Both extinguishers were last serviced on January 9, 2026. Evidence of liability insurance is effective April 5, 2026, and expires on April 5, 2027. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S6), and medication and medication administration record. LPA Kim observed there is no physician order for the postural support for R1 and R2. LPA Kim conducted interviews with 2 staff. A deficiency was cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed R1 and R2 have a postural support attached to each of their beds without a physician’s order. An exit interview was conducted, and a copy of this report, LIC809D, LIC811, and appeal rights were provided to Administrator Irvin Harris Mendoza.the state’s words, verbatim · CDSS document, Apr 24, 2026

Type of visit: Required - 1 Year

This LIC809 was created at 3:00pm on 01/13/2025. LPA arrived to the facility at 8:30am and ended the visit at 10:45am. LPA conducted the Required-1 Year visit but was unable to open a Facility Evaluation Report (LIC809) due to Program being down. The following was provided to Administrator Irvin Harris on the attached Word document: Facility Name: Casa De Los Arboles Time Began: 8:30am Administrator: Roy Sweeny Time End: 10:45am Address: 6482 Via Arboles, Anaheim Hills, CA 92807 Capacity: 6 Census: 5 Type of Visit: Required 1-Year Met With: Irvin Harris C. Mendoza ------------------------------------------------------------------------------------------------ Licensing Program Analyst (LPA) Lydia Martinez made an unannounced Required 1 – Year inspection at this facility. LPA introduced herself and stated the purpose of the visit. LPA was granted entry into the facility by Caregivers Rodelio Manalo and Marlawm Logrono. Administrator Irvin Harris arrived shortly after. LPA, along with AD Harris conducted a tour of the inside and outside of the facility. LPA spoke with 3 of the 5 residents during today’s visit. LPA observed residents to be clean and warm. Facility was observed to be clean and in good repair and is kept at a comfortable temperature for the residents in care. LPA reviewed 5 resident files and 2 staff files during today’s visit. Medication was observed to be in a centrally stored location and medication reviewed appeared to have been dispensed accurately. Due to computer glitch, LPA is unable to leave a Facility Evaluation Report (LIC809). LPA reviewed this report with AD Harris and copy was sent to AD's email for signature. (see LIC809C) On 01/14/2025, there are 5 Residents and 3 staff present during the visit. One resident is receiving Hospice care. LPA toured the physical plant. LPA observed the facility to be clean, sanitary and in good repair. The home is maintained at a comfortable temperature. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each Resident comfortably. Bathrooms were checked, toilets/water faucets worked properly and shower was free of mold/mildew. Hot water temperature was within regulatory requirements. Bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Kitchen is clean and organized. Perishable and non-perishable food supply was checked and adequately stocked. LPA observed sharps and cleaning supplies are inaccessible to the Residents. Smoke detectors and carbon monoxide detector tested operational; Fire extinguisher was fully charged and mounted. No bodies of water were observed outside. Walkways around the home were clear of hazards. Exit gates are unlocked and self-latching. Patio table with chairs was observed. There is no record of Emergency/Fire Drills being conducted. LPA observed emergency supplies, including food and water. LPA observed a twin bed and personal belongs in storage room connected to the dining room. Per AD, room is being used as a staff room. LPA observed the half of the single car garage was converted into a staff room and office. The Fire Clearance granted on 12/14/2017 states "Garage shall be used for vehicles only. Garage shall not be used for any habitable space." Based on observations made during the visit conducted on 01/13/2025 the following deficiency is being cited. This report was discussed with the facility Representative and a copy of LIC809, LIC809C, LIC809D Appeal Rights were sent to email on file.the state’s words, verbatim · CDSS document, Jan 14, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Jan 15, 2025

Fire Safety - All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidenced by: Based on LPA's observation, interview, and record review, licensee did not comply with section cited above in that the single car garage is being used as a staff room and office which poses an immediate health, safety or personal rights risk to staff and persons in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Licensee will immediately cease using garage as staff bedroom by close of business day of 01/15/2025. An immediate Civil Penalty accompanies this deficiency.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87307(a)(2)(B) · Plan of correction due date: Jan 15, 2025

Personal Accommodations & Services -(B) No room commonly used for other purposes shall be used as a bedroom for any person. (A) Such rooms shall include but not be limited to halls...garages, storage areas, and sheds, or similar detached buildings. This requirement is not met as evidenced by: Based on LPA's observation, interview and record review, licensee did not comply with the section cited above in that storage room in dining area is being used as a staff room which poses an immediate health, safety or personal rights risk to staff and persons in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Licensee will immediately cease using storage room in dining area as a staff bedroom by close of business day on 01/15/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 1569.695(c) · Plan of correction due date: Jan 17, 2025

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter...An actual evacuation of residents is not required... Documentation of the drills shall include the date...This requirement is not met as evidenced by: Based on interview, licensee did not comply with section cited above which possess a potential health and safety risk to persons in care. Drills are not being conducted, no log to review.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Licensee to review section cited, self certify understanding. Will conduct a drill by 01/17/2025 and submit proof to LPA. Licensee to ensure quarterly drills are conducted and documented.