Crown Manor II

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Ivashia Wright and Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPAs were greeted by caregiver John Jacob, notified them of the purpose for the visit and were allowed to enter the facility to conduct the inspection. Agnes Martinez the licensee arrived shortly after. Facility Overview: The facility is a single story building with five (5) residents bedrooms, three and half(3.5) bathrooms, Two(2) common areas, a kitchen area and a garage. There is no gated pool and there are no firearms on the premises. Infection Control: LPAs observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with an expiration date of February 28, 2026. The water temperature was tested within regulations measuring at 119.3 F Care & Supervision/Administration: Adequate staff were present to supervise residents during the visit. The Administrator holds a current administrator’s certificate with expiration date of December 28th, 2027 and a CPR certification with the expiration date of August 28th, 2027 Record Review and Resident/Staff Files: LPAs reviewed files for two(2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three (3) residents' files were reviewed and contained all required documentation. LPAs observed first aide kit to be locked and inaccessible to the residents in care. The residents and staff files were kept in a locked cabinet in the common area and inaccessible to unauthorized individuals Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPAs reviewed medications for two(2) residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on 2-2-2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Licensee Agnes Martinez.the state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by Licensee Agnes Martinez, notified her of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with five (5) residents bedrooms, three(3) bathrooms, Two(2) common areas, a kitchen area and a garage. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers to be in compliance with the department requirements and with an expiration date of February 25, 2025. The water temperature was tested within regulations measuring at 118.3 F Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of December 29, 2025 and a CPR certification with the expiration date of August 20th, 2025 Continued 809-C...... Record Review and Resident/Staff Files: LPA reviewed files for three(3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three (3) residents' files were reviewed and contained all required documentation. LPA observed first kit to be locked and inaccessible to the residents in care. The residents and staff files were kept in a locked cabinet in the common area and inaccessible to unauthorized individuals Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPA reviewed medications for three(3) residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on 1-5-2025, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Licensee Agnes Martinez.the state’s words, verbatim · CDSS document, Feb 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA was greeted and was granted entry and met with Licensee and Administrator, Agnes Martinez, who was informed of the purpose of the visit. At time of visit there were (4) residents and (3) staff present. The facility is a one story home with (5) bedrooms and (4) bathrooms with attached garage. The facility does not have a pool or fire arms. The facility is a residential care facility for the elderly serving elderly ages 60 and above. LPA observed the following: Infection Control: LPA observed hand hygiene supplies, PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has a infection control plan on file. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. The carbon monoxide detector was tested and operational during the visit. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required food items. Record Review and Resident/Staff Files: LPA reviewed staff files and training along with CPR/First Aid. Resident files were reviewed and possessed all required paperwork, except for Resident #1 (R1) file which did not have an updated LIC602 with last LIC602 dated 9/10/2021, for resident with diagnosis of dementia. Deficiency and plan of correction was documented with licensee. One resident Resident #2 (R2) also did not have a written record of care on file. deficiency was cited and plan of correction was created with licensee. Health Related Services/ Incidental Medical Services: All client medication was locked in a kitchen cabinet. LPA reviewed client medications and found that MARS and medication was accounted for and had required labeling. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing last fire drill conducted on 1/11/2024. An exit interview was conducted where a copy of this report, along with LIC809-D page, LIC9098 form, and appeal rights were reviewed and provided to Licensee and Administrator, Agnes Martinez.the state’s words, verbatim · CDSS document, Feb 22, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.