Cottages at the Colony of Valley Glen #1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:32AM. The LPA met with the Administrator Anna Lee and informed them of the reason for the visit. Entrance interview conducted. Beginning at 9:47AM the LPA and Administrator toured the physical plant areas inside and outside. At this time, the facility was under construction for renovation. The facility had no residents as they were relocated to the Licensee’s subsequent facilities. A copy of the building permits and floor plan were made available and accessible. Bedrooms, restrooms, common areas, kitchen, records, and medications were not reviewed at this time. Facility records were stored and maintained at the Administrative offices at a nearby facility. The report was amended due to missing signatures. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Mar 4, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 01/24/2025. LPA Mosley entered the facility at 12:30 p.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator arrived shortly thereafter. LPA met with the Administrator, Anna Lee and explained the reason for the visit. The LPA briefly 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. RECORDS: Resident Records were reviewed beginning at 12:42 p.m. and personnel records at 1:10 p.m. Four (4) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Five (5) personnel files including the 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. All records were in order. INTERVIEWS: Two (2) staff and one (1) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report provided.the state’s words, verbatim · CDSS document, Feb 25, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Erica Mosley conducted a Case Management - Incident visit to follow up on a self-reported incident which took place on 1/2/2025. At 12:58 p.m. LPA Mosley was greeted by staff and Administrator, Anna Bernice D. Lee and the reason for the visit was explained. Entrance interview. On 1/2/2025, it was reported that Resident 1 (R1) walked out the facility at night around 11pm and fell into a rose bush outside the facility. At this time the alarm was activated, and staff responded and assisted the resident. The staff notified the Administrator and called 911. When the paramedics arrived, they examined the resident and advised facility staff, Staff 1 (S1) and Staff 2 (S2) of the residents elevated heart rate and suggested the resident be taken to the emergency room for further observation. During today's visit, from 1:00 p.m. LPA conducted a physical plant tour to ensure there were no immediate health and safety concerns. LPA tested all exit door alarms, and they were functioning during today’s inspection .Starting at 1:20 p.m, conducted in-person interviews three (3) staff including the Administrator. LPA also conducted a file review along with obtained copies of pertinent documents relevant to the incident. Interviews with the staff revealed that the resident does not have any history of elopement or wandering. Staff state that this incident was unlike the resident’s typical behavior and believe it could be due to the change in medication. Staff state that the day of the incident at around 11pm the alarm was activated because the resident went out the front door and fell into a rose bush and appeared confused. The staff called the paramedics, and the resident was transferred to the hospital for further observation and evaluation. Report Continued on LIC 809C... Report Continued from LIC 809... Interview with the Administrator revealed that the incident that occurred is unusual behavior for the resident and have not experienced this type of behavior from R1. It was noted that the change in medication can be the possible cause of R1 being confused. The Administrator states when the resident returns to the facility the resident will be closely monitored along with live in staff frequently monitoring the resident at night upon arrival. File review support that there have not been any other incidents pertaining to elopement or wandering for R1. File review support that the resident had recently returned from a Skilled Nursing Facility with a change in medications. The Administrator also showed the LPA still shots from video footage of the caregiver assisting the resident when they existed the facility and information obtained from the incident reveal staff responded timely to the incident. No deficiencies were observed during today’s inspection. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Jan 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 12:58 p.m. Upon arrival, LPA Mosley was greeted by staff and Administrator. LPA met with Administrator, Anna Bernice D. Lee and the reason for the visit was explained. Entrance interview. The LPA 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. GARAGE/BACKYARD: The garage is maintained locked at all times. LPA observed an adequate amount of emergency food and water. There is a laundry area, with a washer and dryer. Laundry detergent was observed in a locked cabinet inside the home. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. BEDROOMS: There are six (6) total bedrooms in the facility; five (5) bedrooms are designated as private resident rooms and one (1) staff room. The staff room is kept locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) restrooms. One (1) is designated as private resident restrooms and two (2) are designated as shared/ common resident restroom. Resident restrooms were observed to be equipped with nonslip surface. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured all resident restrooms and ranged between 108.6-109.2 degrees Fahrenheit, all within the required range. Report Continued on LIC 809C... Report Continued from LIC 809... 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. At 1:49 p.m., hardwire combination of smoke / carbon monoxide detector and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 10/08/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 12/02/2024 and are conducted quarterly with the next one scheduled in March. The facility had the second annual automatic sprinkler system checked and passed on 06/21/2024. Activities were observed in the common areas. The fireplace in the living room was adequately screened. Cleaning supplies and other chemicals are kept in a locked hallway closet adjacent to the entrance inaccessible to residents in care. KITCHEN: The LPA inspected the kitchen/food service area at 1:08 p.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 116.1 degrees Fahrenheit at 1:09 p.m. MEDICATIONS: Medications review began at approximately 3:12 pm. The medications are in a locked cabinet adjacent to the kitchen. Medications for three (3) residents were reviewed. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. Infection Control / Emergency disaster planning: During today’s visit the LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate. LPA obtained the following documents - Resident roster, LIC 500, and copy of the Limited Liability insurance. Due to time constraints the LPA will return to complete the annual at a later date. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Emily Peraldi and Sandra Urena arrived at the facility unannounced to conduct a required annual visit. At 9:30 a.m., the LPAs met with staff and explained the reason for the visit. During the time of the visit, the Administrators, Anna Bernice D Lee and Eleanor Jimenez arrived at the facility. At 9:56 a.m., the LPA along with staff, 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 six (6) bedrooms, five (5) for resident use and one (1) for staff use and three (3) bathrooms. KITCHEN: The LPAs observed the kitchen and dining area. Knives are stored in a locked 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 9:48 a.m., the kitchen faucet was measured at 115.8 degrees Fahrenheit. Medications are located in a locked cabinet near the kitchen. A first aid kit is located near the kitchen. 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. The LPA observed hallway closets 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 10:05 a.m., the hot water temperature for restrooms were tested and measured within the required range. Sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC-809-C. OUTDOOR SPACE: At 9:59 a.m., the LPA observed the back patio. There are bodies of water on the premises at the time of the visit, but the pool is fenced and locked. The pool is drained however due to recent rain, water has accumulated. Laundry units, cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside the locked garage. There is one (1) gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. COMMON AREAS: The LPA observed common areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 10/12/2023. At 10:15 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. RECORD REVIEWS: Starting at 9:55 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. All files were in order. 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. At approximately 10:56 a.m., the LPAs conducted a review of medication and medication documentation with staff for five (5) 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 10, 2024