Comfort Living for Seniors II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection visit. LPA was greeted by facility administrator Donabell Saddi. Facility is a Residential Care Facility for the Elderly that has a fire clearance approved for six residents, there are six residents in care. LPA and admin toured the building and grounds which was found to be clean and in good repair. Facility was clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 05/11/2026. Fire alarms and carbon monoxide detector were tested and operational. Outdoor emergency exit clear from obstruction. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Facility kitchen, refrigerators and freezers were clean, and food was stored properly with expiration dates noted. Toxins are stored in a locked cabinet and inaccessible to residents. Sharps and knives were locked in kitchen drawer. LPA advised admin to have separate food for emergency enough to meet for 72 hours. Facility had an ample supply of linens, towels and extra hygiene products for residents. All bedrooms were equipped with lighting, a night stand and chest of drawers. All bedrooms were clean and in good repair. Resident bathroom had required bath mat and grab bar. Water temperature measured at 110 degrees F at faucets accessible to residents which is within the allowable range of 105 to 120 degrees F. Disaster drills are being conducted and working phone accessible for residents. continued onto 809-C.... continued from 809..... LPA reviewed 6 of 6 resident records. All required documentation was present. Physician reports were up to date. LPA reviewed 3 staff records. All required documentation was present and training up to date LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked med closet. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report- (Retrieved during Visit) LIC308- Designation of Responsibility Liability Insurance No deficiencies cited during today's visit Copy of report given and read with administratorthe state’s words, verbatim · CDSS document, Jul 8, 2026

Type of visit: Required - 1 Year

At approximately 9:50 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Administrator Donabell Saddi was contacted and arrived at approximately 10:10 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with two (2) Hospice residents currently in care and is approved for all non-ambulatory residents and two (2) bedridden. At approximately 10:20 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 5/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 116.9- and 116.2 degrees F, which is within the allowable range of 105- to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed one (1) locked shed in the backyard the contents of which consisted of seasonal decorations and overflow storage. Facility has an internet access devise and internet available to residents in care, and the phone was observed operational during today's inspection. Continued 809C... Continued from LIC809... Facility conducts monthly disaster drills, and the most recent drill was conducted 7/25. LPA observed facility's infection control plan and emergency disaster plan. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 11:00 AM LPA conducted a review of five (5) resident records. All required documentation present. At approximately 11:20 AM LPA conducted review of two (2) staff records. All required documentation present. At approximately 11:30 AM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Donabell Saddi Administrator Certificate 7004461740 expires 4/28/2026. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: Liability Insurance LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jul 22, 2025

Type of visit: Required - 1 Year

At approximately 1:40 PM on 06/12/2024, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by caregiver, Mildred Mamaradlo, Caregiver. Administrator, Donnabell is out of the country. The facility is a single story home licensed for six (6) non-ambulatory residents and hospice waiver capacity of two (2). The facility currently provides care for six (6) residents. Six out of six residents were at home and six out of six residents were eating or watching television for leisure. In addition, there are six (6) residents with a diagnosis of dementia and one resident on hospice. At approximately 2:00 PM, LPA and caregiver toured the building and grounds which was found to be clean and in good repair. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility laundry room and kitchen .LPA observed insect killer in backyard accessible to residents. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water temperature measured within regulation between 111 and 114 degrees F at six of six faucets accessible to residents. One of One Fire extinguisher inspected was charged. Four of four Smoke detectors and One of one Carbon Monoxide detector was present and inspected. Disaster Drills are conducted quarterly with the last drill conducted 06/2024. There was enough lighting in all common areas, resident rooms, and hallways. LPA to continue annual at a later date. Continued on 809C Continued from 809 At approximately 4:00 PM on 06/28/2024 , Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual continuation required inspection of this licensed senior care facility. LPA was greeted by caregiver, Mildred Mamaradlo,( MM) provided LPA with Client and staff files. Administrator, Donabell Saddi arrived shortly after. At approximately 04:15 PM, LPA reviewed 6 of 6 Client records which were all found to be well organized , thorough, and contained the required documentation. LPA reviewed 4 of 4 Staff records, which were all found to be well organized but did not contain the required documentation, 4 of 4 staff files missing LIC501 and 2 of 2 staff records are missing LIC503-Medical Assessment and TB screening. Administrator to provide to CCLD, LPA advised Administrator all staff records must be kept at facility at all times. First aid and CPR certification were current in staff files reviewed. Administrator's Certificate is expired as of 04/28/2024 and pending per documentation provided from CDSS CCLD website. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility LIC610D- Disaster Plan (updated with non-local evacuation site) Resident Roster LIC501 LIC503/TB Screening Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Civil Penalties assessed . Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in further civil penalty assessment. Appeal rights were given on 06/12/2024the state’s words, verbatim · CDSS document, Jun 12, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Nakagawa arrived unannounced for the purpose of reviewing the physical plant for capacity increase. LPA was greeted by caregiver, who contacted Administrator, Donabell Saddi, who arrived shortly. LPA toured the facility, including the bedroom involved in the capacity increase. Licensee is requesting capacity increase from 6 to 7. Currently resident R1 is using alternative furnishings but according to regulation R1 must have access to a bed as well as the alternative furnishing. Administrator will discuss with family. All other bedrooms were found to have required furnishings and had an ample supply of linens. The facility was clean and staff was attentive to residents' needs. No deficiencies noted at the time of this visit in the areas toured by LPA.the state’s words, verbatim · CDSS document, May 21, 2024

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Stefanie Mutialu and Jill Nakagawa arrived unannounced to conduct an inspection of the facility and found 6 residents in care. There were 2 care staff on site. Licensee arrived 15 minutes later. LPAs inspected the facility and found 5 of 6 residents socializing in the living room and watching television. The rooms were clean and had appropriate bedding. Kitchen was clean and had ample supply of perishable and nonperishable food, as required per Title 22. During inspection LPAs observed an unlocked shed with potential hazards inside, including pesticides, paint, sharp tools. Also, LPAs observed an unsecured can of disinfectant, over-the-counter medications and an inhaler during the inspection of bathrooms. LPAs provided facility with Regulation 87309(a) and 87705(f)(2). Deficiency/ies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with facility Licensee, whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Apr 29, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Apr 29, 2024

87705 Care of Persons with Dementia(f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.This requirement was not met as evidence by:** This requirement is not met as evidenced by: Based on LPAs observation over-the counter drugs and inhalers were found unsecured which poses an immediate threat to residents in care which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 29, 2024

Plan of correction: Licensee failed to ensure that toxin, medicationss and other items that could constitute a danger to the resident(s) were stored inaccessible to residents in care with dementia. Licensee immediately locked the items in designated cabinets. In addition, Licensee is to ensure medications and cleaning supplies are kept secured and submit a Proof of Corrections to CCLD by POC due date 4/30/24.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Apr 29, 2024

87309(a) STORAGE SPACE - Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.This requirement was not met as evidence by:** Based on observations LPAs found storage shed in backyard unlocked containing sharp tools, pesticides located in the backyard to be tools and chemicals accessible to residents. In addition, LPAs found 4 knives and 1 pair of large scissors located in drawer in kitchen unlocked and unsecured. This poses as an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2024

Plan of correction: Licensee failed to ensure sharps, tools and toxic chemicals were kept secured and inaccessible to residents in care. Licensee agrees to purchase a new lock for shed door for staff and complete signage posted in the facility to ensure future compliance. Photos of signage and new lock submitted to CCL by POC due date 4/30/24.