Cecile's Place

Type of visit: Required - 1 Year

On 07/06/2026 at 11:40am, the Department conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the annual inspection. Licensing Program Analyst (LPA) Zina Brown met with Chelesa Pollard (Administrator) and the purpose of the visit was discussed. Facility is licensed to serve 6 non-ambulatory residents of which in one maybe bedridden. All rooms approved for bedridden/non-ambulatory and a wavier granted for 3 hospice residents. 4 residents are diagnosed with dementia and 3 are receiving hospice care services. The facility does not handle any of the residents’ money. The facility holds a Administrator Certification for Chelsea Pollard #6073436740 (valid 01/01/2025 - 01/02/2027). The facility annual fees are a balance of $495.00 due June 26, 2026. LPA provided the facility with PIN #788097 with the option to make payment online. The facility liability insurance with Kinsale Insurance Company (Policy #0100391140-0) valid 08/13/2025 - 08/13/2026 with general liability at $1,000,000 and aggregate limit at $3,000,000. The home is a single story home consisting of: (4) resident bedrooms, (2) Full bathroom a half bathroom in the garage, den/living room, kitchen with a formal dining area, laundry area that houses a washer and dryer (located in the attached garage) and an outdoor shaded patio area. On 07/06/2026, between the hours 12:00pm - 12:22pm, LPA toured the 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, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 118.F in kitchen, in bathroom 1 at 114.6F and in bathroom 2 at 116.6F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons. On 07/06/2026, between the 12:30pm - 2:45pm of LPA conducted a records review of (4) resident records, (0) staff records, (4) clients Personal & Incidental Records and reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 at the time of visit. Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8); the Department observed the following deficiencies: 1. Resident 3 (R3) is utilizing half bed rails is no longer on hospice. Upon record review of R3's file did not have a physicians order on file for the use half bed rails. 2. All records for 5 staff and for 5 staff are incomplete such as LIC 501, LIC 503 with TB Test, First Aid/CPR, Annual Staff Training for S1, S2, S3, S4, & S5 S2 - S5 not being associated to the facility at the time of unannounced annual inspection. 3. All records for residents (Resident 1 - Resident 5) are incomplete such LIC 601, 603, LIC 613, LIC 625 and Admission Agreement is missing for R1, R2, R3, R4, R5 LIC 602 with TB Test Results is missing for R1, R5 4. Upon medication review, LPA observed not listed on the MAR 6 PRN's for R2 not listed on the MAR R4's Furosemide not listed on the MAR R5's medication not listed on the MAR 5. The Department asked for the last date of the last emergency drill. The administrator stated they have had a emergency drill about 3 months ago but did not have documentation of the time and date drill was conducted. An exit interview was conducted Chelsea Pollard (Administrator), and a copy of Report and Appeal Rights provided.the state’s words, verbatim · CDSS document, Jul 6, 2026

Type of visit: Prelicensing

On June 9, 2025 Licensing Program Analyst (LPA), Deborah Lee conducted an announced visit to the facility for the purpose of conducting a pre-licensing evaluation. An application was submitted to CCLD, for opening a new Residential Care Facility for the Elderly (RCFE). Fire clearance approved on September 26, 2024. LPA met with Denise Cuthkelvin, Applicant and explained the purpose of today’s visit. LPA and Applicant toured the physical plant(inside and outside). Overview of Facility: Facility is a single-story home located in a residential neighborhood. Entry way of the home is clear and free of debris and obstruction. There are 4 resident bedrooms, 3 bathrooms, living/common room, formal dining room, kitchen and attached garage that houses the washer and dryer. The Resident's bedrooms are spacious and easily accommodate the resident furnishings. LPA observed that there are no bodies of water on the premises. The shaded area and outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility Page 1 of 3 Client Bedrooms: Bedrooms 1-4 have working lights, working windows with no bars. There will be 2 private rooms and 2 shared room. Bathrooms: All Bathrooms have a working toilet, wash basins and shower, and observed to be clean, safe, and sanitary. LPA observed adequate lighting throughout the entire facility. Linens & Hygiene Supplies: Extra linens are available to residents when need. Living/common room is fully furnished with sofa 2 chairs, mounted TV, and covered fireplace. Kitchen is clean and sanitary with a 4 seated counter/bar area. LPA observed a 7-day supply of non-perishables and 2 day supply of perishable. LPA observed area where sharps will be locked and inaccessible to the Residents in care. The formal dining area is equipped with a 6 seated dinning set. Facility has a lanline phone for emergencies. There are 2 fully charged fire Extinguishers located in the kitchen area and garage areas of the home. LPA observed all required postings: See something say something, resident rights, resident counsel, emergency disaster plan, facility sketch and exit signs. Smoke Detectors: Facility smoke detectors/carbon monoxide detectors are hardwired and interconnected. They were tested and operable. Appliances: LPA observed all kitchen appliances and washer and dryer in working order The residence is equipped with heat and air conditioning. Toxins: Applicant showed LPA, where toxins to be locked/stored. Page 2 of 3 Water Temperature: Tested at 108.6 degrees F. Resident & Staff Files: Resident and staff files will all be stored in locked closet located in a hall closet. There are no corrections needed. Component III: Conducted during today’s Pre-Licensing visit. A copy of report provided to applicant. Page 3 of 3the state’s words, verbatim · CDSS document, Jun 9, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participants: Denise Cuthkelvin, LLC Member; Chelsea Pollard, Administrator Interview Method: Telephone interview On 5/19/25, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 19, 2025