College Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Licensee, Dominica Oliva and stated the purpose of today's visit. LPA Rai observed 4 staff and 5 residents at the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 6 resident rooms, 2 staff room, living room, dining room, kitchen and garage. 6 Out of 6 resident bedrooms had available bedding, drawers, and functioning lights. 4 Out of 4 facility bathrooms had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom sinks ranged from 113.5 - 117.1 degrees F. Fire extinguisher was observed and inspected on 05/18/2026. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 04/15/2026 and 01/12/2026. LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Dominica Oliva and a copy of the report was provided. LIC 858 and LIC 859 were provided.the state’s words, verbatim · CDSS document, Jun 25, 2026

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds. There are 6 private client bedroom--2 with private half bathrooms--and 2 full bathrooms, as well as living room, family room, dining room, kitchen and staff room. All client rooms have direct exits to outside. The backyard is level, fenced and paved. Washer and dryer are located in one of two garages; the other garage is used by two live-in staff. No accessible bodies of water or fire safety hazards are observed. PPE supply is adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Soap and paper towels are present in bathrooms and kitchen sink. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature tested at 118 degrees. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 5 residents present, and 2 staff. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as valid first-aid training. Dominica Oliva (x 2/26) is a certified RCFE administrator that oversees facility operations. Client records are reviewed, and Centrally Stored Medications Records are maintained for clients' medications. Licensee is requested to submit the following information/forms by 6/4/25: - Designation of Facility Responsibility (LIC308) - Facility Floor Plan (with dimensions, including staff room designations and bathrooms) - Bedridden Plan of Operation - Proof of current Liability Insurance Deficiencies of the RCFE Regulations, California Code of Regulations, Title 22, Division 6, are cited on following pages. See also Technical Violations issued--2 pages.the state’s words, verbatim · CDSS document, May 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: May 21, 2025

POSTURAL SUPPORTS Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement was not met, as there are 2 full bed rails used for clients #3 and #4, which poses an immediate health, safety or personal rights risk to clients in care. Licensee failed to prohibit the use of full bed rails.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: Full bed rails for clients #3 and #4 were shortened to half bed rails in LPA's presence. Deficiency corrected and cleared

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(6) · Plan of correction due date: May 22, 2025

INCIDENTAL MEDICAL CARE (h)(6) A record of centrally stored Rx medications for each resident shall be maintained and include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength and quantity, dates filled, started & expiration, prescription number and instructions. This requirement is not met, as medications for client #2 are not recorded on Centrally Stored Medications Record, which poses an immediate health, safety or personal rights risk to clients in care. Licensee failed to ensure that all client medications are logged in CSMR.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: All medications will be recorded on Centrally Stored Medications Records, including for client #2. Proof of correction will be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(3) · Plan of correction due date: Jun 4, 2025

POSTURAL SUPPORTS A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. This requirement was not met, as there are no MD orders on file for half bed rails for clients #1, #2, #3, #4. Licensee failed to maintain MD orders for half bed rails, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: Written MD orders for half bed rails for clients #1, #2, #3, #4 will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(26) · Plan of correction due date: Jun 4, 2025

GENERAL FOOD SERVICE Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirment is not met, as there is not eough canned fruit and vegetables for 7 day supply. Licensee failed to maintain 7-day supply of canned fruits and vegetables, which poses a potetial health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: Seven day supply of canned fruits and vegetables will be maintained. Proof of correction to be sent to CCLD BY DUE DATE.

Type of visit: Required - 1 Year

On 6/26/2024, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator, Dominica Oliva. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas, kitchen area & garage. The indoor and outdoor passageways were free of obstruction. Staff is clearing out wood planks and other trash due to garbage pick up this morning. LPA observed some residents were in the dining room having snacks and watching tv. While touring the facility it was observed that the room temperature was at 70 deg F. Hot water was also tested in the bathrooms and the temperature was 110 deg F. The residents have adequate amount of linens and incontinence care items. All personal belongings are intact. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current. Resident bedrooms and bathrooms were observed to be in good repair equipped with grab bars and non-skid mats. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Emergency drills are logged and done every quarter. Five resident records and five staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Facility has a certified administrator, certificate still pending status. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. LPA requested the following: Certificate of Liability Insurance and LIC500. LPA received LIC308. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Jun 26, 2024