Country Gardens Terrace

Type of visit: Required - 1 Year

On July 2, 2026, Licensing Program Analysts (LPAs) Brandon Lopez and Tran Nguyen made an unannounced visit to the facility to conduct the required annual inspection. LPAs were greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Mary Jean Catacutan was notified via telephone but was unable to assist with today's inspection. LPAs observed that Mary Jean Catacutan has a valid Administrator certificate which expires on August 2, 2027. Designee Arjan Banez later arrived to assist with the inspection. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for six. The facility consist of six private resident bedrooms, six bathrooms, a staff bedroom, a living room, a dining room, a kitchen, and an attached two car garage. LPAs, accompanied by the Designee, conducted a tour of the interior portions of the facility. On today's visit, there were five residents in care and two care giving staff present. LPAs observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPAs inspected the six private resident bedrooms and observed them to be clear of any hazards. LPAs observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPAs observed resident beds to have clean linens and blankets. LPAs observed additional linens to be stored in a hallway closet. LPAs inspected the six bathrooms and observed them to be clean. Resident bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 111 and 116.7 degrees Fahrenheit. LPAs observed the staff bedroom to be free of any hazards. LPAs observed the facility has a two day perishable and a seven day non-perishable food supply in the kitchen. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. CONTINUED ON LIC809-C LPAs observed a fire extinguisher to be in the kitchen and it was observed to be charged and up to date on service. LPAs tested the wired smoke detectors and individual carbon monoxide detector which tested operational. LPAs observed the facility did not conduct an emergency disaster drill in the last quarter as required. LPAs observed the facility conducted their last emergency disaster drill on January 7, 2026. LPAs observed the centrally stored medication to be kept in a locked cabinet located in the kitchen. LPAs observed a first aid kit to be stored in the kitchen. LPAs observed the facility did not have an approved first aid manual on hand at the facility. LPAs observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPAs observed the garage to be used for storage and laundry. LPAs observed chemicals and toxins to be stored in a locked cabinet located in the garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPAs, accompanied by the Designee, conducted a tour of the exterior portions of the facility. LPAs observed the exterior to be clear of any obstructions or hazards. LPAs observed a shaded outdoor seating area with furniture for resident use. LPAs observed the perimeter gates of the facility to be self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPAs reviewed all five resident files. LPAs observed that Resident #2 (R2) Medical Assessment dated April 9, 2026, states that R2 is bedridden. During the visit, LPAs met with R2 and confirmed that R2 is bedridden due to R2 being unable to reposition herself on her own. Staff present during the visit confirmed that R2 is no longer able to reposition herself on her own and relies on the assistance from staff to be repositioned. Based on the facility current fire clearance, they are not allowed to retain a resident who is bedridden. During the file review, LPAs also observed that Resident #3 (R3) currently has a gastrostomy tube. Under California Code of Regulation Section 87615, a gastrostomy tube is considered a prohibited health condition. Under California Code of Regulation Section 87633, a facility is only allowed to retain a resident with a prohibited health condition if they are actively receiving hospice services. During the file review, LPAs confirmed that R3 is currently not receiving hospice services. During the visit, LPAs observed and verified that R3 currently has a gastrostomy tube in place. LPAs reviewed the residents' medication and medication administration records. LPAs reviewed three staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. An immediate civil penalty will also be assessed in the amount of $500.00 for a fire clearance violation. An exit interview was conducted with Designee Arjan Banez. A copy of the report and appeal rights were provided at time of visit.the state’s words, verbatim · CDSS document, Jul 2, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for deficiencies issued on 07/25/2025 during the required annual inspection. LPA was greeted and granted entry by staff and discussed the purpose of the inspection. LPA reviewed resident files and check water temperature to verify deficiencies had been corrected. LPA reviewed files for three residents. Water temperature measured 105.3 degrees F. Facility keeps a daily water log. LPA reviewed in-service training document dated 07/26/2025 reviewing locking medication cabinet, locking cleaning supplies and hazardous materials, auditing food, and locking garage door at all times. Based on LPA's observation on today's visit, the Plan of corrections has been fulfilled by the assigned POC due date of 07/31/2025, thus clearing the Type B deficiencies CCR 87465(c)(2), 87506(b)(15), 87309(a)(1), 87555(b)(8), and 87303(e)(2). An exit interview was conducted and a copy of this report was provided to the facility representative.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents, with 3 residents on hospice. Administrator (AD) Mary Jean Catacutan arrived shortly to conduct facility tour. LPA along with staff toured the facility at 8:40 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of 6 resident bedrooms, staff room, living room, dining room, and kitchen as well as 6 bathrooms. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 8:49 AM, LPA observed cleaning chemicals in an unlocked cabinet through an unlocked door in the garage. At 8:57 AM, LPA observed four cans of expired food in the hallway closet. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured 103.2 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans. Facility conducts quarterly emergency drills with the last drill conducted on 04/07/2025. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. Continued on LIC809-C dated 07/25/2025 First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise and games. LPA observed the emergency food and water supply. LPA reviewed five resident files and two staff files. Three out of five resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Jul 25, 2025

The state marks this report as 10 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA met with Jean Catacutan, Administrator and explained the nature of the visit. There are six residents at the facility and there is two residents receiving hospice services currently. LPA began the tour of the inside and outside of the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the bathroom and LPA measured the hot water temperature which measured 107.4 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink and locked storage cabinet garage. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment. LPA observed a charged fire extinguish mounted on the wall of the kitchen. Fire drills are conducted every three months. LPA began review of records. LPA reviewed two resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 23, 2024