Cottages at the Colony of Sherman Oaks #3

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 11:48AM. The LPA met with the Administrator Anna Lee and informed them of the reason for the visit. Entrance interview conducted. Beginning at 11:49AM, the LPA and 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: OUTDOOR AREA: The rear yard had a shaded patio area equipped with furniture in good condition for resident and visitor use. Exits and passageways were free of obstructions. There were two (2) emergency side exits with a self-latching gate. There was a shed that contained emergency water and general storage. The facility had a secured garage that contained laundry machines in operating condition and general storage. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. A fireplace was observed in the living room that was screened and inoperable. Required postings were observed in the entryway. Facility hallway closets included extra linens, secured medications, and secured cleaning supplies. The facility maintained a comfortable temperature throughout the visit and nightlights were observed throughout the hallways. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were seven (7) total bedrooms: six (6) private resident rooms and one (1) secured staff room. The facility was approved for six (6) bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There were five (5) total restrooms in the facility: three (3) private and two (2) shared. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. One (1) shared restroom had a secured closet with personal hygiene products. Hot water was tested and was within the required range. KITCHEN: The LPA observed knives stored inaccessible. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food as well as emergency food. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. RECORDS: Record review began at 12:13PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Fire extinguishers were observed and last serviced on 10/07/2025. Emergency disaster drills are conducted quarterly, with the last documented drill on 12/01/2025. Smoke and carbon monoxide detectors and fire door were tested at 12:55PM and were operational. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 12:57PM. Medications were centrally stored and kept inaccessible in the hallway. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 25, 2026

Type of visit: Required - 1 Year

This report is being created, due to a report being created inaccurately for Cottages #1 instead of Cottages #3 on 03/05/2025. Licensing Program Analysts (LPAs) Sandra Urena and Quoc Huynh arrived at the facility unannounced to conduct a required annual visit. At 9:50 a.m., the LPAs met with staff and explained the reason for the visit. Administrator, Anna Lee arrived at the facility shortly thereafter. The LPAs, and the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. The facility is a single-story residential home with seven (7) bedrooms, six (6) for resident use and one (1) for staff use and five (5) bathrooms. COMMON AREAS: The LPAs observed common areas to be relatively clean and properly furnished. The LPAs observed the fire extinguisher to be fully charged and last serviced on 10/09/2024. The fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. Facility telephone was observed during the time of the visit. LPAs observed cameras in the common areas, and throughout the exterior perimeter of the facility. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 73 degrees. Night lights were present in the hallways. KITCHEN: The LPAs observed the kitchen and dining area. Knives are stored and inaccessible at the time of the visit. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Food labels were observed for expiration dates. Hot water measured at 113.5-degree Fahrenheit. LAUNDRY: Laundry units are located in the garage area. BEDROOMS: The LPA observed the residents’ bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. Continues on LIC809C... RESTROOMS: Restrooms were clean and sanitary and in operating condition with grab bars and non-skid mats. The hot water temperature was measured at 113.5 degrees Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: LPA observed the back patio which has a covered outdoor area for resident use. There are two gates on each side of the house designated for an emergency exits. The property is gated. There are no bodies of water on the premises. RECORDS: Records review began at 11:30 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 11:55 a.m.; medications are centrally stored and locked in a cabinet in the kitchen area; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. The LPAs reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability of Insurance - Emergency Drill Logs No deficiencies observed at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Emily Peraldi and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. At 9:00 a.m., the LPAs met with staff and explained the reason for the visit. At 9:40 a.m., the Administrator, Anna Bernice D Lee arrived at the facility. Entrance interview. At 9:44 a.m., the LPA along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. The facility is a single-story residential home with seven (7) bedrooms, six (6) for resident use and one (1) for staff use and five (5) bathrooms. The property has an attached garage and remains inaccessible to residents. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. LPA observed a hallway closet with extra towels and linens for resident use. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Starting at 9:47 a.m., the hot water temperature was measured in four (4) resident bathrooms, and they measured between 70.5 and 119.1 degrees Fahrenheit. The Administrator had maintenance adjust water temperature during the time of the visit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC-809-C. KITCHEN: The LPAs observed the kitchen and dining area. Knives are stored in an inaccessible kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Food labels were observed for expiration dates. At 10:01 a.m., the kitchen faucet was measured at 111.2 degrees Fahrenheit. Medications are located in a locked cabinet adjacent to the kitchen. A first aid kit is located near the kitchen. OUTDOOR SPACE: At 9:45 a.m., the LPA observed the back patio which has a covered outdoor area with a table and chairs for resident use. There are two gates on each side of the house designated for an emergency exits. The property is gated. Passageways were free and clear from obstruction. There are no bodies of water on the premises. Laundry units and laundry detergents are located inside the garage, which remains inaccessible to the residents. COMMON AREAS: The LPAs observed common areas to be relatively clean and properly furnished. The LPAs observed the fire extinguisher to be fully charged and last serviced on 10/12/2023. At 10:02 a.m., fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. Facility telephone was observed during the time of the visit. LPAs observed cameras in the common areas, and throughout the exterior perimeter of the facility. Night lights were present in the hallways. Cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside a locked hallway closet. RECORD REVIEWS: Starting at 9:15 a.m., the LPAs conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. The following was observed: two (2) out of two (2) home health signed written agreements were not present in resident files during the record review. One (1) out of one (1) hospice resident did not have a current and complete hospice care plan maintained at the facility. At 10:40 a.m., the Administrator identified and printed out the above records and placed missing records in resident files. All files were in order. The Administrator’s certificate is active and expires on 01/11/2025. The LPAs requested a copy of valid liability insurance and Facility Emergency Plan and Infection Control Plan. The last emergency disaster drill took place on 03/01/2024. Continued on LIC-809-C. During the time of the visit, the LPAs conducted interviews with one (1) resident. At approximately 11:10 a.m., the LPAs conducted a review of medication and medication documentation with staff for six (6) residents. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 9, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.