Cottages at the Colony of Sherman Oaks #5

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 12:01PM. The LPA met with the Administrator Anna Lee and informed them of the reason for the visit. Entrance interview conducted. Beginning at 12:03PM, 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 obstruction. There were two (2) emergency side exits with a self-latching gate. There was a shed that contained storage and emergency water. The facility had a secured garage that was converted into two (2) staff rooms and also contained laundry machines in operating condition. 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. The facility maintained a comfortable temperature throughout the visit and nightlights were observed throughout the hallways. Report Continued on LIC 809-C KITCHEN: The LPA observed knives stored inaccessible in the kitchen. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. 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. Extra linens were stored in the hallway cabinet with emergency supplies. There were five (5) total restrooms in the facility: three (3) private and two (2) shared. Restrooms were clean, sanitary, in operating condition with grab bars and non-slip surfaces, and one (1) shared restrooms contained a secured closet with cleaning supplies and hygiene products. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 111.7 degrees F and 115.3 degrees F which is within the required range per regulation. RECORDS: Record review began at 12:28PM. 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 03/02/2026. Smoke and carbon monoxide detectors and fire door were tested at 1:01PM and were operational. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 1:02PM. Medications were centrally stored and kept inaccessible in a closet in the entryway. 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, Mar 26, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Annual Continuation Visit to the facility to continue the annual inspection visit initiated on 02/25/2025. Upon arrival, the LPA was greeted by Administrator, Claudette Marasigan and informed them of the purpose of today's visit. Administrator, Anna D. Lee arrived during the inspection. Entrance interview. During today’s visit, at 12:55 p.m., the LPA along with the Administrator toured the physical plant areas to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations and conducted a medication review. The following was observed: The LPA inspected the kitchen area at 01:03 p.m. The facility has a sufficient supply of perishable and non-perishable food. Knives and sharps were observed in a locked drawer inaccessible at the time of the visit. The LPA observed furniture in the common areas to be in good condition. The facility maintained a comfortable temperature. The LPA observed required postings by the main entrance. There is a fireplace in the living room, which was observed to be screened and inaccessible. The LPA observed six (6) resident bedrooms, which were furnished appropriately and had sufficient lighting. The LPA observed two (2) full resident restrooms and a ½ bathroom inside bedroom #6, which were clean and sanitary and in operating condition with non-skid surfaces. Report Continued on LIC 809C... Report Continued from LIC 809... The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The LPA observed cameras in the common areas and outside perimeter. All indoor and outdoor passageways were free from obstructions in case of an emergency. Outdoor areas were observed shaded with sufficient space to conduct activities with furniture suitable for outdoor use. No bodies of water noted at the time of the visit. Records: Records review began at approximately 1:12 p.m. Five (5) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current appraisal. All resident files were in order. Three (3) personnel records including the current 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. Files were complete. Administrator’s Certificate is active until 01/11/2027. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. Both documents were observed to be reviewed and updated annually as required. The facility’s policies and procedures as it pertains to infection control are adequate. Automatic Sprinkler System Inspection was conducted on 06/21/2024 with no deficiencies noted. Fire extinguisher was observed to be fully charged and serviced on 10/08/2024. Emergency disaster drills are conducted quarterly; last drill was conducted on 03/03/2025. Medications: Medications review began at approximately 02:50 p.m. Medications are centrally stored in a locked closet by the main entrance. Medications appeared to be given as prescribed. Exit interview conducted. No citations issued. Report was reviewed and a copy was issued.the state’s words, verbatim · CDSS document, Apr 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the LPA met with staff, Claudette Marasigan and Administrator, Anna Lee and the reason for the visit was explained. Entrance interview conducted. Starting at 9:52AM, the LPA along with Staff 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: Facility is a single-story residence that consists of six (6) resident bedrooms, two (2) staff rooms, and five (5) restrooms. The LPA observed one (1) fire extinguishers which was fully charged and last serviced 10/04/2024. At 10:12AM, all smoke alarms and carbon monoxide detectors were tested and functioned properly. There is a fire door by the main hallway leading into the resident bedrooms. Facility has an adequate amount of emergency food and water; properly stored. The LPA observed all required postings in the hallway near the entrance area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. KITCHEN: The LPA inspected the kitchen/food service area at 10:06AM. Knives and sharps were observed locked and inaccessible in a kitchen drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. At 10:09 a.m., the hot water temperature was measured in the kitchen sink, and it measured at 114.6 degrees Fahrenheit. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. Activities were observed in the common areas. The fireplace was adequately screened at the time of the visit. There is a working telephone on premises. Report Continued on LIC 809C... Report Continued from LIC 809... The LPA observed a complete first-aid kit and manual. Cameras observed in the common areas. No obstructions or hazards were observed inside or out. RESTROOMS: The LPA observed all resident bathrooms. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 9:55AM, the hot water temperature was measured in resident bathrooms, and they measured within the required range at the time of the visit. The LPA observed personal hygiene items for resident use locked and inaccessible at the time of the visit. BEDROOMS: There are six (6) bedrooms for resident use. All bedrooms are designated as private rooms. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. Additional clean linens are available for resident use. GARAGE: The garage was locked and inaccessible to residents at the time of the visit. Washer and dryer were observed inside the garage. Additional cleaning supplies are kept in the garage locked and inaccessible to residents in care. BACKYARD: The backyard has a covered patio area with patio furniture for resident use. The LPA observed a shed for storage purposes. All passageways were observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms and auditory alarms. Cameras were observed in the outside perimeter. No bodies of water noted at the time of the visit. INTERVIEWS: The LPA conducted two (2) resident interviews during the inspection. No concerns were noted. MEDICATIONS: Medications are centrally stored in a locked closet by the main entrance. The LPA will review medications at a later date. FILE REVIEW: The LPA will review facility files at a later date. Due to time constraints an LPA will return to complete the annual at a later date. No citations issued. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Martha Arroyo and Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 3:02 PM, LPAs met with the Administrator, Anna Bernice D Lee and explained the reason for the visit. Entrance interview. At 3:04PM 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 following was noted: The facility is a single-story residential home with nine (9) bedrooms, six (6) for resident use, five (5) bathrooms, and three (3) staff rooms, two (2) of which are inside the Attached Accessory Dwelling Unit (ADU). 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 3:11PM, the hot water temperature was measured in four (4) resident bathrooms, and they measured between 105.3- and 113.5-degrees Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC 809C... Continued from LIC 809... KITCHEN: The LPAs observed the kitchen and dining area. Knives are stored in a locked drawer inaccessible to residents in care. 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 3:10PM, the kitchen faucet was measured at 108.6 degrees Fahrenheit. A first aid kit is located near the kitchen. OUTDOOR SPACE: At 3:04PM, 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 in the ADU which are kept 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 3:20PM, 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 bathroom closet. RECORD REVIEWS: Starting at 3:05PM, 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, and consent forms. Continued on LIC 809C... Continued from LIC 809C... At 3:41PM, records review of R1’s physician’s report, dated 01/31/2024, lists R1 having no capacity for self-care which is a prohibited health condition. At 4:35pm, the Administrator printed updated physician’s report, dated 02/08/2024, which lists R1 is able to feed themselves. Staff files were complete. 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. During the time of the visit, the LPAs conducted interviews with one (1) resident. At approximately 4:08PM, the LPAs conducted a review of medication and medication documentation with staff for five (5) residents. Medications are centrally stored and locked in a closet by the main entrance hallway. At 4:16PM, medication review of R2’s medication revealed that medication Mirtazapine Tablets, USP, 30 mg is missing the prescription label as the medication box which had the prescription label was discarded; therefore, LPAs were unable to determine if medication is being administered as prescribed by physician/pharmacy. Staff state they will make sure they do not discard medication box with prescription label in the future. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Mar 9, 2024