Cinnamon Garden Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10:24 a.m. Upon arrival, LPA met with Administrator Tammy Frame and explained the reason for the visit. Beginning at 10:37 a.m., the LPA along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: The facility is a single-story residential home with six (6) private, single occupancy resident bedrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) restrooms of which two (2) are designated for private resident use and one (1) is a shared, common use. Restrooms were clean and sanitary and in operating condition with grab bars and slip resistant surfaces. The restrooms were sufficiently stocked with liquid hand soap and paper towels; towels and washcloths are not shared. The hot water temperature was measured in all restrooms and measured within the required range. LAUNDRY ROOM: LPA observed the locked laundry room with a washer and dryer. Cleaning supplies and detergents were observed locked and inaccessible at the time of the visit. BACKYARD: The backyard has an area equipped with outdoor furniture including a table and chairs for resident use with appropriate shade. Facility has an in-ground pool, which was observed to be fenced with Report Continued on LIC 809-C an appropriate lock. Outdoor exit gates were observed to be self-closing and self-latching at the time of the visit. Emergency exits and passageways were observed free of obstructions and hazards. COMMON AREAS: At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 01:16 p.m., hardwired combination smoke and carbon monoxide detectors were tested and were operational at the time of the visit. The three (3) fire extinguishers were observed to be fully charged and last serviced on 05/15/2026. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 05/11/2026 and are conducted quarterly. Activities were observed in the common areas. The facility has a working telephone on the premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction. KITCHEN: Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Food labels were inspected and checked for dates and expiration. The knives and sharps were observed in a locked drawer inaccessible. Cleaning supplies were observed to be locked under the kitchen sink. Medications are stored in locked kitchen cabinets. GARAGE: The garage was observed locked and inaccessible to residents at the time of the visit. The facility has a sufficient supply of emergency food and water which was observed to be in good condition. LPA observed a freezer in the garage, the food was inspected for dates and food labels that had expiration dates clearly marked. The garage also contains a seating/rest area for staff. RECORDS: Records review began at 11:10 a.m., five (5) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, current needs and services plan, and hospice records. All records were in order. Five (5) personnel records, including the Administrator’s file, were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, LPA reviewed the facility’s infection control practices and emergency disaster plan. The facility's policies and procedures as they pertain to infection control and emergency preparedness are satisfactory. Report Continued on LIC 809-C MEDICATIONS: Medications review began at 12:06 p.m. Medications are centrally stored and locked in a kitchen cabinet. Medications requiring refrigeration are securely stored in a locked box inside the refrigerator, which is kept in the garage that remains locked at all times. Medications for two (2) residents were reviewed. Medications are labeled and checked for expiration dates. All medications were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed. INTERVIEWS: One (1) staff and two (2) resident interviews were conducted during the inspection. No concerns were noted or voiced at the time of the visit. DOCUMENTS: Documents obtained during the visit include: LIC 500 personnel roster, LIC 610E and current liability Insurance. No deficiencies cited. Exit interview conducted. A copy of the report was reviewed and issued.the state’s words, verbatim · CDSS document, Jun 10, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct an unannounced Case Management - Annual Continuation to continue the inspection that began on 05/09/2025. LPA Mosley entered the facility at 10:10 a.m. Upon arrival, LPA Mosley was greeted by staff and Administrator. LPA met with Administrator, Tammy Frame and explained the reason for the visit. The LPA and Administrator briefly toured the physical plant areas inside and outside at 10:20 a.m. to ensure there were no health and safety hazards and facility is in compliance with Title 22 Regulations. Entrance interview conducted. Infection Control / Emergency disaster planning: During today’s visit LPA Mosley reviewed the facility’s infection control practices and emergency disaster plan. The facilities policies and procedures as they pertain to infection control and emergency preparedness are satisfactory. RECORDS: Records review began at 10:51 a.m., five (5) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, current needs and services plan, and hospice records. All records in order. At 12:08 p.m. three (3) Personnel records including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Report Continued on LIC 809-C (PAGE 2) Report Continued from LIC 809... MEDICATIONS: Medications review began at approximately 1:26 p.m. Medications are centrally stored and locked in a kitchen cabinet. Medications requiring refrigeration are securely stored in a locked box inside the refrigerator, which is kept in the garage that remains locked at all times. Medications for five (5) residents were reviewed. Medications are labeled and checked for expiration dates. All medications were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, and current Liability Insurance. No deficiencies cited at this time. Exit interview conducted. A copy of the report was reviewed and issued.the state’s words, verbatim · CDSS document, May 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:45 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator arrived shortly after. The LPA met with Administrator Tammy Frame and explained the reason for the visit. The LPA along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. INTERVIEWS: From 9:49 a.m. – 10:07 a.m. One (1) staff and two (2) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. COMMON AREAS: At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 11:07 a.m., smoke detector(s) and carbon monoxide detectors were tested and operational at the time of the visit. The three (3) fire extinguishers were observed and fully charged on 5/8/2025. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 03/25/2025 and conducted quarterly. Activities were observed in the common areas. The facility has a working telephone on the premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction. GARAGE: The garage was observed locked and inaccessible to residents at the time of the visit. The facility has a sufficient supply of emergency food and water which was observed to be in good condition. LPA observed a freezer in the garage, the food was inspected for dates and food labels that had expiration dates clearly marked. Report Continued on LIC 809C... Report Continued from LIC 809... KITCHEN: The LPA inspected the kitchen/food service area at 10:11 a.m. The hot water temperature was measured at 10:12 a.m. and measured at 107.8 degrees Fahrenheit within the required range. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Food labels were inspected and checked for dates and expiration. Dates and food labels had expiration date clearly marked. The knives and sharps were observed in a locked drawer inaccessible. BEDROOMS: The facility is a single-story residential home with six (6) private, single occupancy resident bedrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) restrooms of which two (2) are private resident use and one (1) is a shared, common use. Restrooms were clean and sanitary and in operating condition with grab bars and slip resistant surfaces. The restrooms were sufficiently stocked with hand liquid soap and paper towels; towels and washcloths are not shared. The hot water temperature was measured in all restrooms from 10:22 a.m. – 10:27 a.m.; and measured between 109.5 – 113.9 degrees Fahrenheit all within the required range. LAUNDRY ROOM: LPA observed the locked laundry room with a washer and dryer. Cleaning supplies and detergents were observed locked and inaccessible at the time of the visit. The LPA observed a sufficient supply of Personal Protection Equipment (PPE). BACKYARD: The backyard has an area equipped with outdoor furniture including a table and chairs for resident use with appropriate shade. Facility has an in-ground pool, which was observed to be fenced with an appropriate lock. Outdoor exit gates were observed to be self-closing and self-latching at the time of the visit. Emergency exits and passageways were observed free of obstructions and hazards. Documents obtained: LIC 500 Personnel Report, LIC 9020 Resident Roster, and Liability Insurance. Due to time constraints an LPA will return to complete the annual at a later date. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 9, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kelly Dulek conducted a pre-licensing visit to this property at 11:10AM. LPA met with applicant representatives Rowena Carrillo and Kamran Ghasri. The applicant has obtained fire clearance for 5 (five) non-ambulatory in bedrooms 2,3, and 4 and 1 (one) bedridden in bedroom 5 with a total capacity of 6 (six) residents. The proposed facility has a pending Dementia care plan and an approved hospice care waiver for 6 (six) residents. Applicant completed component II interview on 02/27/2024. During today's visit, Applicant representatives completed component III with the LPA. Beginning at 11:20AM, LPA inspected the proposed facility for Fire Safety, Personal Accommodations, and Food Service. All hard-wired combination smoke alarm and carbon monoxide detectors were tested at 01:53PM and function properly at this time. Fire extinguisher was observed to be fully charged and recently purchased. Paint, windows, blinds, and floors are in good repair. There are no firearms on the premises. The common living and dining areas are clean and properly furnished. A properly screened fireplace was observed in the living room. A working telephone is present. All required postings were observed in the common area. The facility contains a locked laundry room. All chemicals and cleaning supplies were observed locked inside the laundry room. A locked medication cabinet was observed in the kitchen, as well as a locked cabinet designated for record storage. First aid kit was observed to be complete. Garage was observed to be locked and inaccessible to future residents and contained storage for extra food and supplies. The proposed facility has 6 (six) bedrooms total all of which are designated for private resident use. All bedrooms observed were furnished and contained beds, chairs, bedside tables and lamps. All beds have appropriate linens. There is also an ample supply of linen, towels and paper products. The proposed facility has 3 (three) bathrooms, 1 (one) is designated for shared resident use and 2 (two) for private resident use. LPA observed night-lights were present in the hallways. Hot water initially measured slightly higher than theReport Continued on LIC 809-C required temperature. Water temperature was adjusted during the visit, LPA retested the water, and it measured within the required range prior to the end of the visit. The kitchen contained a sufficient supply of dishes, glasses and utensils. A seven-day supply of non-perishable food is present, as well as, a seven-day supply of emergency water. Knives and other sharps were stored in a locked cabinet under the kitchen sink. Building and grounds were observed. Patio area contains a seating area for future resident use. Facility has an in-ground pool, which was observed to be fenced with an appropriate lock. Outdoor exit gates were observed to be self-closing and self-latching at this time. All passageways were observed to be clear of any hazards. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 5, 2024