Eastern Manor

Type of visit: Required - 1 Year

On 9/30/2025 1:30 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with the facility designated administrator Geronima. The current census is 12 with 2 facility staff. This facility is a single story building licensed to serve (13) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 105.3 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen area and was last serviced on 7/21/2025. LPA observed the facility has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 73 degrees Fahrenheit. LPA observed toxins located in the kitchen kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 4 out of 12 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 6 out of 12 resident files and they were complete. LPA reviewed 3 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents were provided today: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulations, and a copy of the LIC 809 report were provided to the facility.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Vincent Moleski and Holly Williams arrived unannounced to conduct an annual inspection. LPAs Moleski and Williams met with facility administrator Geronima Bautista and explained the purpose of the visit. LPAs Moleski and Williams reviewed 5 resident files (R1-R5) and two staff files (S1-S2). LPAs Moleski and Williams toured the facility with Bautista and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. LPA Williams observed broken closet doors in 2 bedrooms. One room had closet doors that were broken and barring the resident from accessing their clothes. The second bedroom had a closet door which was off the railing. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 98.7 degrees Fahrenheit, which is not within the required range of 105 and 120 degrees. Licensee was given a Technical Violation for the water temperature. Licensee turned water up while LPAs Moleski and Williams were conducting the inspection. LPAs Moleski and Williams observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPAs Moleski and Williams observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPAs Moleski and Williams observed a locked cabinet for the storage of medication. LPAs Moleski and Williams observed locked cabinets for the storage of cleaning solutions and knives. LPA Williams observed a prescription medication bottle, in a unlocked drawer, in the kitchen. LPA Williams observed detergent and bleach unlocked in the laundry room. LPA Moleski interviewed one staff member (S3) and two residents (R2,R5). This facility is being cited per 22 CCR Section 87303(a), 87465(h)(2) and 87309(a). An exit interview was held with Geronima Bautista. Appeal rights and a copy of this report were emailed to Bautista.the state’s words, verbatim · CDSS document, Oct 3, 2024

Allegation investigated: Staff did not provide resident's authorized representative with medication records Staff not providing medication to resident as prescribed

Licensing Program Analyst (LPA) Jamie Ivey Canady arrived at the facility unannounced to deliver complaint findings. LPA met with Geronima Bautista and explained the purpose of today's visit. The investigation was conducted by the Department. The investigation consisted of interviews with staff, review of resident medical reports, facility chart notes and facility resident files. The Department has determined the following as it relates to the allegations: Staff did not provide resident's authorized representative with medication records and Staff not providing medication to resident as prescribed. Continued on LIC 9099 - C... Page 1 of 2 Unsubstantiated On 12/22/2023 Licensing Program Analyst (LPA) Jamie Ivey Canady conducted interviews with facility witnesses regarding current complaint allegations. It was learned that facility staff was asked for resident medical files and medicinal prescription lists for R1. According to witness statement on 12/22/2023, a list of medications for R1 was provided to R1 physician by R1 POA. Based on interviews with facility staff, R1 POA did not provide permissions to pass along R1 medical information and provided requested documents directly to R1 physician. Therefore the allegation Staff did not provide resident's authorized representative with medication records is unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. On 12/22/2023, 12/26/2023 and 1/09/2024 Licensing Program Analyst (LPA) Jamie Ivey Canady conducted facility medical chart review for R1 and R2. According to medical chart review all medications are logged in accordance with Title 22 regulations. All charts are date stamped and signed by facility staff for AM and PM medications that are handed to R1 and R2. On 12/26/2023 LPA observed all facility medications for 12/26/2023 PM placed in small cups for preparation for the day's administering. Based on facility medical file review and facility resident file review, medications listed for R1 and R2 are administered as prescribed. Therefore the allegation Staff not providing medication to resident as prescribed is unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22 no deficiencies cited. Exit interview was held and a copy of report was given to facility administrator Geronima Bautista.the state’s words, verbatim · CDSS document, Jan 18, 2024 · control 27-AS-20231218151501