Columns Care Home

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. The facility is licensed for 6 non ambulatory residents of which 1 may be bedridden in room 4 only. The facility has a hospice waiver for 6 residents. This facility is a one-story home with 4 residents’ bedrooms, 1 staff bedroom and 3 bathrooms with an attached garage. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in the bathrooms. The hot water temperature measured 114.9 and 120.6 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an emergency drill on 09/12/2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed secured medication storage in a secured kitchen cabinet. LPA observed emergency food in the kitchen pantry and water in facility garage. LPA reviewed three out of three staff training and fingerprint records and conducted a complete review of 5 out of 5 residents files. Administrator has a current administrator certificate which expires on 08/28/2027. No deficiencies noted. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 12, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Samer Haddadin conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA met with Administrator (AD) Catherine HSI and explained the reason of the visit. This facility is a one-story home with 4 residents’ bedrooms and two bathrooms and one staff room and one staff restroom. LPA toured the inside and outside of the facility and noted the following: Facility appeared clean, safe, and sanitary. All residents’ rooms had required elements, including bed, chair, closet space, and ample lighting. Facility had extra linens and hygiene supplies for all residents. Restrooms were stocked with soap and paper towels. Hot water measured at 106.1 degrees Fahrenheit in both bathrooms. LPAs observed the facility had a two-day supply of perishables and a seven-day supply of non-perishable. LPA observed hallways and walkways were free of obstruction. LPA observed the fire extinguisher was charged based on the arrow pointing into the green zone. The service tag indicated the extinguisher was last serviced on October 9th, 2024. Facility staff tested smoke and carbon monoxide detectors, and all were operational. Chemicals and toxins are locked up in the garage and under the kitchen sink. LPA noted the facility's knives and sharps were secured and locked in a kitchen cabinet. Medication for each resident was kept locked and secured and inaccessible to resident in care. LPA reviewed two residents’ files and medications, which no discrepancies were observed. LPA reviewed two staff files. All files of staff and residents contained all required documentation. Upon review of records, the facility is up to date with required quarterly fire drill, which was last conducted on November 6th, 2024. The administrator certificate expires on August 28, 2025. No deficiencies were noted during today's inspection visit. An exit interview was conducted, and a copy of this report was provided to the facility AD.the state’s words, verbatim · CDSS document, Dec 20, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived at the facility and was greeted and granted entry by designated Administrator (AD) Cathy Hsi. An application to operate a Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden clients was received by Community Care Licensing (CCL) on 5/4/2023. Structure: The facility is a one-story home with four resident bedrooms, two bathrooms, living room, kitchen, dining room, backyard, staff room, staff bathroom and three car garage. There are two exit gates in the back yard. The latch on one exit gate is slightly rusted. AD stated they will have maintenance person address this. Client Bedrooms: All resident bedrooms had the necessary furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. Bedrooms with doors leading to the backyard also had alarms to notify staff of open doors. Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to client and will be stored under the kitchen sink and above the laundry machines. Medications, First-Aid Kit & Files: Medication will be stored in a locked cabinet in the kitchen. The First Aid Kit had all the required elements and is stored with medication and facility records. Fire Extinguisher: LPA observed the fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone Component III: Information provided about how to operate the facility within compliance and reporting requirements. Activity Materials: The facility has exercise equipment, books, card/board games and art supplies. Fire clearance: Was approved by a fire inspector of Orange County Fire Authority on 5/23/2023. Bathrooms: The bathrooms have working plumbing. Hot water measured at 109.4 degrees Fahrenheit in the common bathroom and 107 degrees Fahrenheit in the bathroom in one of the shared rooms. Linens: A supply of extra linen is stored in the hallway closet Emergency Phone Numbers, Exit Plan and Menu: Posted and available for review. Food Service: There is 2-day supply of perishable food and a 7-day supply of non-perishable food on hand. Smoke Detectors: Smoke detectors and carbon monoxide detectors were tested and observed to be operational. Appliances: Gas stove, oven, refrigerator, dish washer, microwave, washer, and dryer are operational. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.the state’s words, verbatim · CDSS document, Nov 30, 2023

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Facility Type: RCFE Capacity: 6 Census (if any clients in care): Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Sep 28, 2023