Elite Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 04/03/2026 and was greeted by Caregiver Jorge Cabatay. Administrator Gladys Pervez arrived shortly after. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip mat in showers. Bathroom#1 was observed to be wheelchair accessible. Video surveillance was observed in common areas. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 02/22/2026. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. SEE 809-C Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. During record review LPA did not observe a signed statement by R3's roommate, indicating their acknowledgment that R2 intends to receive hospice care and R3's voluntary agreement to grant access to the shared living space to hospice caregivers, and resident's support network of family members, friends, clergy, and others. LPA interviewed R3 and R3 verbally confirmed they do not have issues or concern in sharing a room with R2 even though R2 is receiving hospice care. R3 signed a statement prior to LPA’s exit, therefore, LPA did not issue a deficiency. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Gladys Pervez 02/08/2027. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel record reviewed. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) non-ambulatory residents and may retain two (2) hospice residents. There are currently two (2) residents on hospice care. Resident Records/Incident Reports: LPA reviewed resident records for five (5) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon conducted an unannounced required annual visit. LPA met with Caregiver, Liana Wati, who contacted administrator. Assistant Administrator Robert Santamaria joined the visit at 9:45 AM. The facility serves six (6) non-ambulatory elderly residents of which one (1) may be bedridden, ages 60 and above. Facility is approved for five (5) hospice residents. LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: REVIEW OF FILES · Resident Admission Agreements, Resident & Staff files, Staff fingerprint clearance, Medications, Staff First Aid Certificate, Resident Physician reports, resident medical consent. FACILITY PHYSICAL PLANT · Four (4) resident bedrooms and one (1) office/staff room inaccessible to residents, two (2) bathrooms (only 1 used for residents), attached car garage, shaded outdoor area, living room, kitchen and dining room, and front and back yard. LPA reviewed three (3) staff files and four (5) resident files. Interview was conducted with one (1) staff and one (1) resident. Report continues on page 809C... Observations during facility tour: · Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPAs observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for residents. · Wall and floors are in good repair. Hallways were clean and free of obstructions. · Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable. · Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean. · The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees. · Sharps are locked in a closet and inaccessible to residents. Also, chemicals and toxics are locked and secured inaccessible to residents. · Smoke and carbon monoxide detectors were observed and are interconnected throughout the facility. One (1) fire extinguisher was observed and was fully charged with last inspection in April 2024. · Front and back yards are free of hazards and there were no bodies of water present at facility. Shaded area was available to residents. · First Aid kit was inspected and in compliance. · The medications are centrally stored and locked in a cabinet in kitchen. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all six (5) residents. LPA observed the following deficiencies in the administration of medication. Prescribed medication for resident R2 was missed for three (3) out of six (6) medications (Amolodipine 5 mg, Quetiapine 50 mg, and Trazodone HCL 50 mg). Prescribed medication for resident R4 was not properly administer when needed for blood pressure (Midodrine HCL 10 MG). In addition, prescription was being administer to resident and bubble pack had been rupture but not properly log on the records for three (3) out five (5) Residents. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D pages. Exit interview held and a copy of the report LIC9102 Technical Assitance, LIC809 and LIC809D along with appeal rights were provided to assistant administrator Robert Santamariathe state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced required annual visit. LPA met with Administrator, Gladys Pervez, who assisted with the visit. The facility serves six (6) non-ambulatory elderly residents of which one (1) may be bedridden, ages 60 and above. Facility is approved for five (5) hospice residents. Facility fees are current. Administrator certificate is current with expiration date is 02/08/25. During the visit, CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff/residents were interviewed, files were reviewed, and medications were reviewed. The facility is a single family house located in a residential neighborhood; consisted of a living room, office, laundry room, dining room, kitchen, five (5) resident rooms, two (2) common bathrooms, front yard and backyard. Residents' rooms are furnished with appropriate furniture for residents’ comfort. The bathrooms are furnished with grab bars and nonskid surfaces. Adequate linen and personal hygiene supplies are observed. Common areas are observed for the ability to safely serve the needs of the residents. Smoke detectors and carbon monoxide detector are tested and operational. Fire extinguishers are fully charged. Facility maintains a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable. Sufficient supply of perishable and nonperishable foods is observed. Hot water temperature is measured at 119.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Fire drill was conducted on 03/15/24. Medication are centrally stored in a locked storage room and inaccessible to residents. Resident records are stored in a locked storage room and inaccessible to residents. No deficiencies were observed per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Gladys Pervez, who’s signature on this form confirm receipt of these documents. A copy of LIC 809 report was provided.the state’s words, verbatim · CDSS document, Apr 25, 2024