Cypress Estate Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA met with Jeanina Lita, Administrator Designee, and stated the reason for today's inspection. Also present was care staff, Annaliese Anderson. LPA observed (4) residents present after returning from day program. The facility is licensed for (6) non-ambulatory residents and has an approved hospice waiver for (4). There are (0) residents currently under hospice care. LPA and the Administrator Designee toured the interior/exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (1) resident bathroom, kitchen, laundry and pantry area. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout. There is 2+ day perishable, including fresh produce, and 7+ day non-perishable food on hand. Hot water measured 112*F in the kitchen, and the facility measured 70*F. Bathrooms have the necessary grab bars, skid-resistant flooring, and hygiene products. Medications and sharps are locked in the kitchen and toxins are secured in the laundry area. Fire extinguisher was last serviced 1/1/2026, smoke/monoxide alarms are functioning, and all doors have working alarms. There are flashlights and night lights throughout. All required postings are in the common area, including "Oxygen in Use" sign. There are games/activities and an operating land line. There are sufficient linens/towels/blankets and PPE. There is a covered patio with a table/chairs and one unlocked exit gate in the backyard. There are no filled bodies of water. LPA reviewed (2) resident files and (3) staff files. Files were organized and contained current/required documentation, including staff training. Staff is cleared/associated. Medications were reviewed for (2) residents. Orders match medications being administered and documentation is current. There are no deficiencies cited during today's inspection. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 14, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection and met with Annaliese Anderson, care staff, who contacted the Co-Administrator, by phone. LPA spoke to the Co-Administrator and was advised she was attending an appointment and was unavailable for a couple of hours. LPA observed resident (R1) seated at the dining room table using their cell phone. (3) residents returned to the facility from day program at the end of the inspection . LPA discussed the recent fall with caregiver, who was at the facility, but did not see the fall. Staff explained (R1) fell around 7:00 pm last night, and sustained a small abrasion on the left side of the forehead. Staff called the Emergency Medical Technicians (EMT's) who arrived and assessed (R1), who declined to go out for further medical treatment. Staff stated she observed (R1) every (30) minutes and noted they were confused about the time until they went to sleep. Staff stated (R1) got up two times during the night, which is normal, and was back to normal this morning. A Home Health nurse and assistant assessed (R1) this morning around 10:00-11:00 am and instructed staff to apply an ice pack and administer Tylenol, as needed. (R1) stated to LPA they fell last night while walking into their room with a cup of water, denied being in pain, and appeared to be coherent. LPA observed (R1) to have a slight bruise on their forehead, to be using a cane, which was provided to them about (2) weeks ago from the Physical Therapist, and was told (R1) previously used a walker in February 2026. LPA reviewed (R1)'s resident file, including physician's report, which notes (R1) is ambulatory and independent with all ADL's. (R1) will continued to be monitored by staff, the Co-Administrator and Home Health, and staff and will contact 9-1-1 if there is a medical emergency. It appears the facility took appropriate steps following the unwitnessed fall. LPA toured the interior of the facility and did not observe any health and safety risks or personal rights violations. There are no deficiencies issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA initially met with Annaliese Anderson, care staff, who contacted the Co-Administrator. The Co-Administrator arrived at 1:30 pm. LPA was advised there are (2) residents who are currently attending their day program. These (2) residents moved in on October 10, 2025. LPA and the Administrator toured the interior of the facility, including the common areas, (2) private resident bedrooms and (2) shared resident bedroom, staff room, bathrooms, kitchen, laundry and patio. All areas were observed to be clean, in good repair and odor free. There was 2+day perishable and 7+day non-perishable food supply. LPA observed locked toxins, medications and sharps. All doors have working alarms, and the fire extinguisher was last serviced November 15, 2024- Administrator will have the extinguisher re-serviced by November 15, 2025. LPA reviewed (2) resident files and (3) staff files. All files were organized and contained current/required documentation. Admission Agreement to be updated per changes made in January 2025. All required postings are in the common area. LPA obtained an updated copy of liability insurance. There are no deficiencies cited during today's inspection. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived announced to conduct a scheduled pre-licensing inspection. LPA met with John Lita, Administrator and Jeanina Lita, Co-Administrator. There is a pending license for (6) residents, all of whom may be non-ambulatory. There are currently no residents present as this location is not currently licensed. LPA and Administrators toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (1) resident bathroom, staff room/bathroom, kitchen, laundry and pantry area. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout. The bathrooms have the necessary grab bars, non-skid flooring, soap, paper towels. All (4) resident rooms are furnished with the required furniture and have closet space also. LPA observed 7+ day non-perishable food, and sufficient dishes, flatware and cooking pans in the kitchen. Sharps and medications are locked in the kitchen, and toxins are secured in the laundry room. Hot water measured 113*F in the kitchen and the inside temperature measured 68*F. Fire extinguishers were last serviced on 11/15/24, and the smoke/monoxide alarms are in working order. There is a complete First Aid kit in the kitchen. LPA observed some PPE supplies on hand. There are paper supplies, sufficient linens/towels/blankets. There are flashlights and night lights on hand. There are games/activities and an operating land line. There is a covered patio with a table and chairs and one unlocked exit gate in the backyard. Required postings are posted in the common area. LPA reviewed (1) resident binder and (1) staff binder. Each binder was organized with tab dividers for the required forms. Cameras have been ordered/received and will be installed soon. Auditory alerts for exit doors have been ordered and will arrive within a week or two. Pre-Licensing is complete and this facility has no deficiencies. LPA to notify the analyst in the applications bureau. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 19, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Lita, John On 2/25/25, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 25, 2025