Cottages at the Colony of Valley Glen #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 10:00AM. The LPA met with the Administrator Anna Lee and informed them of the reason for the visit. Entrance interview conducted. Beginning at 10:03AM, 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: BEDROOMS/RESTROOMS: There were seven (7) total bedrooms: six (6) private resident rooms and one (1) secured staff room. Bedroom #1 had a direct exit to the outside and the facility approved for six (6) bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in a hallway closet. There were four (4) total restrooms in the facility: two (2) 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. Hot water was tested and measured between 106 degrees F and 119.8 degrees F which is within the required range per regulation. Report Continued on LIC 809-C 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 general activity storage, emergency food, locked medications, and locked hygiene products and cleaning supplies. The facility maintained a comfortable temperature throughout the visit and nightlights were observed throughout the hallways. OUTDOOR AREA: The rear yard had shaded patio areas equipped with furniture in good condition for resident and visitor use. During the visit, there was construction observed in the rear yard for a future facility. The construction area was secured and inaccessible to residents in care. Exits and passageways were free of obstruction. There was one (1) emergency side exit with a self-latching gate. The facility had a secured garage that contained general storage, emergency water, and laundry machines in good condition. Attached to the garage was an additional secured staff room. The facility also had an Administrative office that was inaccessible to residents that also had its own private restroom. KITCHEN: The LPA observed knives stored inaccessible in a locked drawer. 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. RECORDS: Record review began at 10:34AM. 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. Report Continued on LIC 809-C 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 as well as fire doors were tested at 11:05AM and were operational. MEDICATIONS: Medication review began at 11:06AM. Medications were centrally stored and kept inaccessible in a medication closet. 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 4, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced Case Management visit to inspect the new additions made to the facility. The LPA arrived at 11:09AM and met with the Administrator Anna Lee who arrived shortly thereafter. Entrance interview conducted. Beginning at 11:21AM, the LPA and Administrator conducted a physical plant tour to ensure the facility was in compliance with Title 22 Regulations. The following was observed: The facility completed permitted construction and converted a previous bedroom into an office space and a previous common area into a bedroom. The converted bedroom will be utilized as a single occupancy private resident bedroom and had all required furniture and sufficient lighting per regulation. The office was inaccessible to residents and had a private entrance through the rear yard with a private restroom. The rear yard was observed to be in the process of site work and will be the construction of a new home, which will be utilized as a future licensed facility. The remainder of the facility was in compliance with regulation at this time, and no immediate concerns were observed. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Oct 13, 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 9:32 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator. The Administrator arrived shortly after. LPA met with Administrator, Anna 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 seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) is designated as a 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 five (5) restrooms. Three (3) are designated as private resident restrooms and two (2) are designated as shared/ common resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface. Grab bars were observed in the bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured all resident restrooms and ranged between 108.6- 113.9 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 12:00 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 all 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 10:19 a.m. The kitchen faucet was measured for hot water temperature, and it measured 116.1 degrees Fahrenheit at 10:19 a.m. Knives and sharps were observed in a locked box that sits on the counter. 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. RECORDS: Record review began at approx. 10:30 a.m. Resident Records were reviewed beginning at 10:33 a.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. All records were in order. Personnel Records were reviewed beginning at 11:07 a.m. six (6) 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. Infection Control / Emergency disaster planning: During today’s visit 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. Report Continued on LIC 809C... Report Continued from LIC 809... MEDICATIONS: Medications review began at approximately 11:46 a.m. The medications are in a locked closet adjacent to the kitchen in the living room area. Medications for four (4) residents were reviewed. Medications reviewed were found to be self administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed. INTERVIEWS: Two (2) staff and Two (2) 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. LPA obtained the following documents - Resident roster ; LIC 9020, Staff roster ; LIC 500, and copy of the current Limited Liability insurance. 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, Feb 27, 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 12:15 p.m., the LPAs met Administrators, Anna Bernice D Lee, Claudette Marasigan, Eleanor Jimenez and Maurice Lau explained the reason for the visit. At 12:20 p.m., LPA Urena, 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. The laundry units are located inside the garage. 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. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Starting at 12:20 p.m., the hot water temperature was measured in all bathrooms and were found in compliance between 105.0 and 120.0-degrees Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. 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. At 12:30 p.m., hot water measured at 1180-degree Fahrenheit. Medications are located in a locked cabinet in the laundry room/area. A first aid kit is located near the kitchen. Continued on LIC-809-C. OUTDOOR SPACE: The LPA observed the back patio which has a covered outdoor area for resident use. There are emergency exits throughout the facility. There are no bodies of water on the premises. 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 12:51 p.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. Cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside a closet near the front entrance. Medications are located in a locked closet near the dining area. RECORD REVIEWS: Starting at 12:40 p.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. During the time of the visit, the LPAs conducted interviews with one (1) out of five (5) residents. Starting at 1:05 p.m., LPA Urena conducted a review of medication and medication documentation with Administrator for three (3) residents and observed that all medications were properly documented. Exit interview conducted. No deficiencies observed at this time. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 11, 2024