Dove Tree Manor

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) LaVette Farlow and Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs met with Illuminada Silvino, Caregiver who granted entry into the facility. Licensed capacity is six (6) current census five (5) with one of the five at a doctors appointment. LPAs was accompanied by Licensee, Eva Fe Sosnovsky to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 degrees F. LPAs inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors, carbon monoxide alarms and extinguishers. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. All sharps are locked in kitchen cabinet/drawer. Overall, the facility is clean, and in good repair, and operating in safe conditions for clients in care. LPAs tested the water temperature and the water measured at 107.8 degrees F. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPAs reviewed two (2) client files for admission agreements, updated physician reports, and needs and services plans, which appears to be maintained and in order. LPAs reviewed and conducted an audit of two (2) residents medications/MAR which staff stated were dispensed but had not been initialed for the morning for 2 out of 2 residents in care. LPA can not verify for accuracy based on the MARs. A Deficiency cited. LPAs reviewed and audited three (3) staff files for Criminal Background Clearance, Health Screening Report, TB test results, Required Training's, CPR/First Aid Certification. LPA observed that 3 out of 3 staff files were accurately maintained and in order. LPAs also reviewed facility folder for Liability Insurance, Fire drills, Emergency Disaster Plan, Infection Control Plan, and Staff and Client Roster. All records were available for review and maintained. Based on the observations made during today’s visit, there were one (1) deficiency cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, LIC809D was appeal rights were discussed and provided to Licensee Eva Fe Sosnovsky at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 12, 2026

Type of visit: Case Management - Other

On 3/27/2026 at 9:43 AM Licensing Program Analyst (LPA) LaVette Farlow conducted a Case Management visit to amend an complaint report. The Complaint number is 56-AS-20250926104459, which was originally crated on 9/30/2025. LPA Farlow amended the report and collected signatures.the state’s words, verbatim · CDSS document, Mar 27, 2026

Allegation investigated: Staff are unable to communicate effectively with the residents Staff are not meeting the needs and services for a resident

This is an amended version of the original report crated on 9/30/2025. Licensing Program Analyst (LPA) Lavette Farlow, conducted an unannounced visit to the facility to commence a complaint investigation regarding the above allegations. LPA was greeted and granted entrance at the door by Caregiver, Iluminada Silvino. LPA identified self and discussed the purpose of the visit. LPA also presented self to Licensee, Eva Fe Sosnovsky and discussed the purpose of the visit. LPA conducted interviews with staff and residents, reviewed documents and did a walk-through of the facility. Allegation: Staff are unable to communicate effectively with the residents. It was alleged that staff can not communicate with residents in care. Interviews conducted with staff and residents revealed that residents are able to communicate with caregivers. S2 stated that we do have a new staff and English is not their first language, but they do speak English. S2 stated S3 does speak English and if S3 needs assistance with communication S3 will ask, but most of the time S3 figures it out. Unsubstantiated LPA did not find any evidence of lack of communication between residents and staff, and no further information was obtained from interviews to provide details of lack of communication in the facility. Based on interviews and LPA observations, the allegation is unsubstantiated. Allegation: Staff are not meeting the needs and services for a resident in care. It is alleged that staff are not meeting the needs of the residents in care. LPA interviewed four (4) residents and three (3) staff. Interviews with four (4) out of four (4) residents revealed that staff are meeting residents needs and services. Residents stated staff assist them with their hygiene needs, and providing them with food and snack. LPA conducted interviews with three (3) out of three (3) staff. LPA's interview revealed that staff assist the residents in care with meals, medication, bathing, and hygiene needs. Based on interviews, and observation the allegation is unsubstantiated. Based on observations, interviews and record review on the above allegations the findings are Unsubstantiated. A finding of unsubstantiated means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and provided to Licensee, Eva Fe Sosnovsky.the state’s words, verbatim · CDSS document, Sep 30, 2025 · control 56-AS-20250926104459

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Illuminada Silvino, Caregiver who granted entry into the facility. Licensed capacity is six (6) current census four(4). LPA was accompanied by Licensee, Eva Fe Sosnovsky to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 71 degrees F. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors, carbon monoxide alarms and extinguishers. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. All sharps are locked in kitchen drawer. Overall, the facility is clean, and in good repair, and operating in safe conditions for clients in care. LPA tested the water temperature and the water measured at 116.1 degrees F. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed three (3) client files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed and conducted an audit of three (3) residents medications/MAR which appears to be maintained and in order. LPA also reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. LPA review of staff files appear to be maintained and in order. There was a designated area for client/staff files. Based on the observations made during today’s visit, there were no deficiencies cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, and LIC809C was discussed and provided to Licensee Eva Fe Sosnovsky at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 30, 2025

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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Bonna Ferrer-Caregiver who granted entry into the facility. Licensed capacity is four (6) current census five(5). LPA was accompanied by Bonna Ferrer to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors, carbon monoxide alarms and extinguishers. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. All sharps are locked in kitchen drawer. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. The hot water temperature tested within regulation at 124 degrees F. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed two (2) client files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed two (2) client medications/MAR which were not signed by facility staff for 3-5 days this poses immediate danger to those in care. LPA also reviewed one (2) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. There was a designated area for client/staff files. Based on the observations made during today’s visit, there was a deficiency cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809, LIC809-C and LIC809-D) was discussed and provided to Bonna Ferrer at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 11, 2024