Devonshire Cottage

Type of visit: Required - 1 Year

On May 22, 2026, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted the administrator-in-training Kristine Cedeno about the visit. Administrator Anna Aldiano was notified via telephone and provided verbal agreement that Kristine can sign the report on her behalf. For this visit, there are two staff members on duty, both of which are background cleared and associated. The PUB475 ‘See Something, Say Something’ poster was observed to be located near the front entrance. LPA observed that Anna Aldiano has renewed her Administrator certificate on May 21, 2026. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, five of which may be non-ambulatory, one of which may be bedridden, and a hospice waiver for six. LPA toured the interior and exterior portions of the facility with Kristine. For this visit, there are a total of three non-ambulatory and two ambulatory residents in care, none of which are on hospice, and none are bedridden. The facility is a two story home. There are a total of five bedrooms, four of which are private resident bedrooms and one is a shared bedroom. LPA toured each bedroom with staff and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the second story is kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of three and a half bathrooms. Continued on LIC 809-C. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathrooms were measured to be between 115.8 and 117.3 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in a kitchen cabinet, inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. Fire extinguisher was dated and tagged on August 21, 2025. LPA observed all the required postings in the hallway. LPA observed the facility conducted their last emergency disaster drill on March 11, 2026. Facility had back-up emergency food and water supply, located in the garage. LPA observed that the First Aid kit had all the required components. Medications were observed to be locked in a storage room, inaccessible to residents in care. Chemicals were observed to be locked in the garage and underneath the kitchen sink. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. The garage is used for storage and laundry. For the exterior portion, LPA observed patio furniture under shading, and the grounds were free of any hazards or obstructions. There are two exit gates in the backyard that can be opened in case of an emergency. No bodies of water were observed. During this visit, five resident files and three staff files were reviewed. All staff are background cleared and associated with the facility. LPA reviewed residents’ medication and medication records and one resident interview was conducted. The facility has valid liability insurance that expires on June 7, 2026. Based on today's observations, there are deficiencies being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with authorized representative. This report was reviewed and a copy was provided at the end of the visit. Appeal Rights were reviewed.the state’s words, verbatim · CDSS document, May 22, 2026

Type of visit: Required - 1 Year

On May 23, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Marebith Nery was notified via telephone and later arrived to assist with the inspection. LPA observed that Marebith Nery has a valid Administrator certificate which expires on July 22, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one can be bedridden, and has a hospice waiver for six. The facility is a two story home with five resident bedrooms, four resident bathrooms, a living room, a dining room, a kitchen, a staff office, and an attached two car garage. LPA, accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed four residents in care and three staff present. LPA observed residents relaxing in their respective bedrooms and eating breakfast in the dining room. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the resident hallway. LPA inspected the five resident bedrooms and they were observed to be free of hazards. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens to be stored in a hallway cabinet. LPA inspected the four resident bathrooms and observed them to be free of hazards. Resident bathrooms were equipped with grab bars and non-skid floors. Faucets and toilets were operational. Hot water temperature measured between 112.4 to 117.3 degrees Fahrenheit. LPA observed the second story of the home to have a staff office. LPA observed the staff office to be off limits to residents in care. CONTINUED ON 809-C LPA observed the kitchen has a two day perishable and a seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed fire extinguishers to be mounted in the kitchen, in the resident hallway, in the garage, and by the entryway of the facility. LPA observed fire extinguishers to be charged and up to date on service. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the centrally stored medication to be kept in a locked closet by the entryway of the facility. LPA observed the facility has a First Aid Kit stored in the locked closet and it has all the required components. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage and laundry. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gates on the north side and south side of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all four resident files. LPA observed the facility did not have a Medical Assessment on file for Resident #2 (R2) and Resident #4 (R4). LPA observed the facility did not have a Pre-admission appraisal on file any of the four residents. LPA reviewed residents' medication and medication records. LPA observed the facility did not have a valid prescription for seven supplements/vitamins for Resident #3 (R3). LPA reviewed six staff files. LPA observed that zero out of three staff that were present at time of visit, did not have a valid CPR card on file. 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 809-Ds. An exit interview was conducted with Administrator Marebith Nery. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, May 23, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived and was greeted and granted entry by Administrator Anna Aldiano. An application to operate a Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by Community Care Licensing (CCL) on 12/8/2023. The facility is a one-story home with five resident bedrooms, three and a half bathrooms, living room, den, dining room, kitchen, covered patio, backyard and 2-car garage. There is a staircase that leads to an office upstairs, however only the first floor is seeking license. There is a locked door preventing resident access to the second floor. Client Bedrooms have all the necessary requirements including bed, chair, storage for clothing and ample lighting. LPA observed all windows were screened. All bathrooms have working plumbing and designated hand washing posters. Hot water measured at 120, 118.6, 118.4 and 118.8 degrees Fahrenheit in the resident bathrooms.. LPA observed the fire extinguishers to be fully charged as indicated by the arrow pointing in the green zones on their meters. LPA observed tags indicating the extinguishers were filled/charged in 2024. Medication and First-Aid Kit will be locked in a closet near the entryway. Resident & Staff Files will be locked in drawers in the dining area. The fire clearance was approved by a fire inspector of Orange County Fire Authority on 2/13/2024. LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and are stored and locked in the garage. A supply of extra linens is stored in a cupboard in the hallway. A supply of extra hygiene supplies is stored in the garage. Emergency Phone Numbers and Exit Plan are all posted and available for review. LPA observed other necessary postings in the hallway. LPA observed an activity calendar and menu. Smoke and Carbon Monoxide detectors are stationed throughout the home and are wired together. Both types of detectors were tested and noted as operational. Resident bedroom doors are equipped with alarms to notify staff if a resident goes outside. Facility also has pendant alert system. Operational appliances include a gas stove, oven, two refrigerators, dishwasher, microwave, washing machine and dryer. LPA reviewed and provided Administrator with the Component III presentation to offer information and resources regarding maintaining facility compliance. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.the state’s words, verbatim · CDSS document, Apr 25, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Aldiano, Anna - Applicant/Administrator Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 03/21/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. 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, Mar 21, 2024