Cervato Cottage

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day and Deborah Lee conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPAs met with Edgar Yraheta, Assistant Administrator and the purpose of the visit was discussed. Facility is licensed to serve (6) ambulatory residents age 60 and over of which 6 resident may be non ambulatory. The facility has an approved hospice waiver for 2 residents. One (1) resident is diagnosed with dementia. No residents are receiving home health services.Two residents are receiving hospice care services. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (6) resident bedrooms, (2) Full bathroom, 1 half restroom, living room, kitchen with dining area, laundry room and an outdoor patio area. 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 between 118.1F. 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 the premises. No Deficiencies observed at time of visit. Exit interview conducted with Edgar Yraheta, A copy of this report was provided at time of visit.the state’s words, verbatim · CDSS document, Jan 21, 2026

Allegation investigated: Staff physically abused resident while in care.

On 04/22/2025, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced complaint investigation for the allegation listed above. On 05/08/25, LPA Regina Cloyd conducted a subsequent visit to gather information regarding the above allegation. On 06/05/25, LPA Cloyd met with Administrator Assistant Edgar Yraheta to deliver findings. Investigation consisted of the following: On 04/22/25, LPA requested the following documents: Personnel Report/ Staff Schedule (LIC500), Resident Roster (LIC9020), Resident (R1-R2) Admission Agreements, 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, Staff (S1-S2) Personnel Records which includes Personnel Record (LIC501), and Training Records. On 05/08/25, LPA interviewed two residents (R2 - R3), the Administrator (S1), three caregivers (S2 – S4), four witnesses (W1 – W4), and reviewed R1’s Los Alamitos Medical Center record and medication records. Continue to LIC9099-C. Unsubstantiated LPA observed photo of R1’s bruise and prescription order to discontinue medication. LPA attempted to interview R1 and observed bedrails. On 05/10/25, LPA Cloyd received Nurse Practitioner notes dated 04/07/25 from MedWell Medical. On 06/04/25, LPA reviewed Community Care Licensing (CCL) Clinical Consultant’s Report on R1’s medical documents. Investigation revealed the following: Regarding the allegation, “Staff physically abused resident while in care,” it is being alleged that Resident #1 (R1) sustained bruises across R1’s rib cage and hip. Record review of CCL Clinical Consultant’s Report revealed R1 was prescribed medication for an old diagnosis and that medication can cause bruising. R1 has left upper chest wall bruising towards the abdominal area, radiating to the bilateral flank area (MedWell Nurse Practitioner’s notes 04/07/25 and Los Alamitos Medical Center 04/15/25). Record review of R1’s prescription order revealed that the medication was discontinued on 04/10/25. Four out of four staff (S1 – S4) interviews denied the allegation. Staff (S1 – S3) indicated that R1 tries to get out of bed and could have obtained the bruises from the half bed rail. Interview with W1, R1’s son-in-law, indicated that the physician assistant said the bruises could have appeared from R1’s internal bleeding. Interview with R2 – R3 indicated that they like the quality of care and have not been physically abused while in care. Two out of three witnesses (W2-W4) indicated that their family member hasn’t sustained a bruise due to physical abuse. Regarding the allegation, “Staff physically abused resident while in care,” based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies issued. An exit interview was conducted and a copy of this report was provided to the Administrator Assistant Edgar Yraheta.the state’s words, verbatim · CDSS document, Jun 5, 2025 · control 11-AS-20250421145304

Type of visit: Required - 1 Year

On February 12, 2025 Licensing Program Analyst (LPA) Deborah Lee arrived at facility to conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Jose Umana as the purpose of todays visit was explained. The facility is licensed to operate for 6 ambulatory residents of which 6 can be non-ambulatory, ages 60 and over and is approved hospice waiver for 6 residents. There are 2 residents currently on hospice. Current facility census is 6. Licensing fee status discussed with Administrator at time of visit. Structure: The facility is a single-story structure located in a residential neighborhood and consists of the following: 6 bedrooms, 2 common restrooms, 1 private restroom, laundry room, dining area, kitchen, pantry, linen closet, 1 staff office area and a designated outdoor shaded area. The facility has a working landline telephone. Physical Plant LPA and Administrator Jose Umana toured the facility inside and outside. LPA observed 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. LPA observed that facility had required postings: Facility license, personal rights, ombudsman information poster, facility sketch, exit signs, infectious disease postings, Administrator certificates, an emergency disaster plan. Page 1 of 3 Bedrooms LPA inspected all (6) bedrooms All bedrooms were observed to have the required furniture including beds, dressers, night stands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. The water temperature measured 110.8 degrees Fahrenheit. All bathrooms were observed to be clean, in good repair and within Title 22 regulations. Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in hall closet. . Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked cabinet under the sink and are inaccessible to residents. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. There is a laundry room where the washer and dryer are located. The detergent and other cleaning supplies are locked in a cabinet inaccessible to residents in care. Page 2 of 3 Safety LPA observed and tested smoke/carbon monoxide combo detectors to be fully operable. LPA observed ( 2) fully charged fire extinguishers that was last serviced on 5/16/24. The last emergency drill was conducted on 12/12/24. LPA inspected the First Aid kit and found it contained an ample supply of required items: Scissors, tweezers, gauze, disinfectant wipes, band aids. LPA observed all exits to be clear and easily accessible. All toxins locked and inaccessible to residents in care. Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked cabinet that is inaccessible to Residents in care. Files LPA reviewed ( 4 ) resident files and found that (4) out of (4) contained all the necessary documentation. LPA reviewed (4) staff files and found that (4) out of (4) contained the required documentation, certification, and training. Liability Insurance expires on 02/01/2026. Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff. Outside area: During visit LPA observed the outside grounds (front and back) to be free of clutter, debris, and passage ways were free of obstruction. There were no deficiencies cited during today’s visit. Exit interview conduct and report provided to Administrator Jose Umana. Page 3 of 3the state’s words, verbatim · CDSS document, Feb 12, 2025

Type of visit: Required - 1 Year

On 02/14/24 Licensing Program Analysts (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Jose Umana as the purpose of todays visit was explained. The facility is licensed to operate for 6 ambulatory residents of which 6 can be non-ambulatory, ages 60 and over and is approved hospice waiver for 6 residents. Current facility census is 5. Liability insurance is active, upcoming facility fee information provided. The facility is a single-story structure located in a residential neighborhood and consists of the following: 6 bedrooms, 2 common restrooms, 1 private restroom, laundry room, dining area, kitchen, pantry, linen closet, 1 staff office area and a designated outdoor shaded area. The facility water temperatures measured between 105- and 120 degrees F. The facility has a working landline telephone. There were no bodies of water, no weapons or obstructions on the premises. Resident rooms were inspected, beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked during the visit. All bathrooms were found to be within Title 22 regulations and were clean and operational. All storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA conducted a records review of 2 staff records, 2 resident records, and 2 medication administration records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 12/15/23, 2 fire extinguisher fully charged, carbon monoxide and smoke detectors are interconnected and operational. Exit interview conducted with Administrator Jose Umana, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 14, 2024