Del's Haven IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Assistant Administrator Della Pardo and explained the reason for the visit. The Administrator's certificate (Dianna Manalo) expires on November 15, 2027. The facility is licensed for 6 non-ambulatory residents of which 1 may be bedridden and a hospice waiver for 4. The facility is a single story home with a living room, dining room, kitchen, 5 bedrooms, 1 is shared, 2 bathrooms and a 2 car garage. The garage is kept locked and used for storage. LPA and the Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted next to the front door of the facility. LPA observed all 6 resident rooms have the required furnishings. The smoke detectors/carbon monoxide detectors tested operational. The Fire extinguisher in the hallway is fully charged. Extra linens are stored in the hall closet. LPA observed a 2 day supply of perishable food and a 7 day non-perishable food supply on hand in the kitchen. LPA observed a 3 day emergency food and water supply stored in the kitchen. LPA observed knives are kept locked in a kitchen drawer. LPA observed the medication is kept locked in a kitchen cabinet. LPA observed cleaning supplies are kept locked under the kitchen sink. The 5 burner stove in the kitchen lights unassisted. LPA observed both bathrooms are clean and operational. Hot water measured 109.9 degrees Fahrenheit in both bathrooms. LPA and the Administrator toured the backyard and the garage. LPA observed the garage is used to store extra supplies, food and furniture. The garage is kept locked. The backyard has a table with an umbrella and chairs to sit outside. Both backyard exit gates (one on each side of the house) are operational. No bodies of water observed in the backyard. No obstacles or hazards observed in the backyard. LPA reviewed facility files. The last fire drill was conducted on January 20, 2026. LPA observed the first aid kit has all the required elements. LPA reviewed 2 staff files, both staff members have the required training and CPR training. Both staff members are background cleared and associated to the facility. LPA reviewed 5 resident files and 5 resident medications, no discrepancies observed. Facility did not have a dedicated internet device for resident use (technical violation). No deficiencies observed during the visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Dianna Manalo and explained the reason for the visit. Dianna Manalo's Administrator's Certificate expires November 15, 2025. The facility is licensed for 6 non-ambulatory residents of which 1 may be bedridden and a hospice waiver for 4. LPA and the Administrator toured the facility. The facility is a single story home with 5 bedrooms , 2 bathrooms, kitchen, dining room, living room with a screened fireplace and a three car garage which is kept locked and used for storage. The garage has a storage room/office which is kept locked. LPA observed the See Something, Say Something sign posted in the main entrance of the facility. The last emergency drill was conducted on January 17, 2025. The smoke detectors/carbon monoxide detectors tested operational. The fire extinguishers in the hallway and dining room are fully charged. Puzzles and games are stored in the living room under the large screen TV. LPA observed the kitchen is clean and operational. The 5 burner gas stove lights unassisted. LPA observed a 2 day perishable and 7 day non-perishable food supply in the kitchen, Knives are kept locked in a ktichen drawer. Cleaning supplies are kept locked under the kitchen sink. . LPA observed all resident rooms had the required furnishings and linens. LPA observed both (2) bathrooms are clean and operational, hot water measured 111.3 degrees Fahrenheit in both (2) bathrooms. LPA and the Administrator toured the backyard. No bodies of water observed. There is table with an umbrella and chairs to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA observed the first aid kit has all the required elements. Facility has an internet device (Tablet) for dedicated resident use. LPA reviewed 6 resident records and medications, no discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. Both staff members have the required training. Both staff members are background cleared and associated to the facility. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Feb 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Administrator (AD) Dianna Manalo’s Administrator certificate requirements have been completed and were submitted November 16, 2023 and is pending approval. Del’s Haven IV is a one-story community with five bedrooms and two bathrooms. The facility capacity is 6 and the census was 5 during today’s visit. Residents were observed in the backyard getting some sunlight while exercising, and one resident was in their bedroom during the visit. During the inspection, LPA Haley observed all resident bedrooms and bathrooms. All resident bedrooms had the necessary elements and were in compliance with regulation guidelines. In the resident bathrooms, the hot water temperatures were measured. In bathroom #1 hot water measured at 115.1 degrees Fahrenheit, and in bathroom #2 hot water measured at 111.7 degrees Fahrenheit. No hazardous items were observed in the resident bathrooms. Both showers had nonskid matts and the grab bars were secure. In the hallway, there was a cabinet with clean linens next to bathroom #1. Next to the closet with clean linens was a fully charged fire extinguisher mounted on the wall. There was a second cabinet with extra blankets and a vacuum. There was also a carbon monoxide detector mounted on the wall in the hallway. In the kitchen LPA Haley observed a perishable and nonperishable food supply in compliance with regulation guidelines. Knives and sharp objects are kept locked in the drawer next to the stove. Medications were locked in a cabinet next to the refrigerator. Below the locked medication cabinet, there’s a cabinet with resident and staff files. Continued on LIC809C Hazardous cleaning items are kept locked under the sink. A first aid kit with all the required elements is locked in a cabinet below the kitchen counter. The stove was clean and all five burners were operational. In the garage, there is a supply of facility items being stored in the center of the garage. Walkways were clear and free of obstruction. A backup supply of food items was observed in the refrigerator and deep freezer. There is an emergency supply of COVID PPE items: N95 mask, gowns, and hand sanitizers. All the residents have an emergency bag ready to go, and the facility has a emergency kit prepared and ready to go. In the emergency kit is an emergency food supply, flashlights, batteries, toilet paper and other items. LPA Haley observed an emergency supply of water as well. The backyard was clean and organized. The walkways were clear and free of obstruction. A shaded patio area with tables and chairs was observed. Both exit doors were self-closing and self-latching. Smoke detectors were observed in all resident rooms, the hallways, living room and in the dining room area. During the inspection smoke detectors were tested and were operational. A second fully charged fire extinguisher was observed mounted on the wall in the dining room. An emergency evacuation drill was conducted in February 2024 and will continue to be conducted quarterly for staff on each shift. No deficiencies were observed during today’s visit. An exit interview conducted, and a copy of this report was provided to Administrator Manalo.the state’s words, verbatim · CDSS document, Feb 27, 2024