Elite Manor Melbourne

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Paul Hernandez, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and six (6) residents present. Administrator William Lee arrived at the facility at 1:00 PM. Facility Overview: The facility is a one-story home with six (6) bedrooms and four (4) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 119°F. Fire extinguisher located at kitchen is a new unit per the purchase receipt. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C...... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Six (6) resident files were reviewed and contained all required documentation. Per physician's reports, Resident #2, 3, 4, and 5 were non-ambulatory. This facility was licensed for 1 non-ambulatory resident. A citation was issued. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for four (4) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 10-27-2025, which met department requirements. All facility exits were clear of obstructions. A citation was issued during the visit. An exit interview was conducted, during which this report was reviewed and provided along with LIC809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Nov 24, 2025

Type of visit: Required - 1 Year

On 11/15/2024, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Caregiver, Thania Gonzalez who was informed of the purpose of the visit. Administrator, William Lee arrived during the visit and was also informed of the purpose of the visit. The facility has a fire clearance for one (1) non-ambulatory and five (5) ambulatory elderly residents. As of 10/20/2022, the facility has an approved hospice waiver for one (1). During the visit, there was five (5) residents and two (2) staff present. LPA toured the facility with Caregiver Gonzalez and reviewed records. During the tour, LPA observed indoor and outdoor pathways free of obstructions and there were no bodies of water on the premises. Outdoor shaded seating is available for the residents in care. Resident bedrooms had the required bedding, furniture, and functional lighting. Bathrooms had grab bars in the showers. LPA toured the kitchen and observed the facility has more than a two-day supply of perishable foods and seven-day supply of non-perishable foods, all stored in a safe and healthful manner. Medications are secured in a locked kitchen cabinet. LPA also observed a hallway closet filled with additional blankets, linens, towels, incontinent and hygiene supplies. Administrator Lee tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility. Staff present have a criminal record clearance and are associated with the facility. The facility's certificate of liability insurance expires on 11/23/2025. A physical record review revealed Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), and Resident 4 (R4) are receiving hospice services at the facility; therefore, the facility was cited for violation of their current hospice care waiver. Additionally, Administrator Lee showed LPA digital records of R1, R3, R4 and Resident 5's Physician's Reports noting they are all deemed non-ambulatory. This violates the facility's current fire clearance. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Lee along with an LIC 809-D, Confidential Names list (LIC 811) and Appeal Rights.the state’s words, verbatim · CDSS document, Nov 15, 2024

Type of visit: Required - 1 Year

On November 07, 2023, Licensing Program Analyst (LPA), Venus Mixson made an unannounced visit to the facility to conduct an annual licensing inspection, and met with the Administrator William Lee. The LPA introduced herself and stated the purpose of the visit. LPA Mixson toured the facility along with the Administrator, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is licensed to serve six residents, five may be ambulatory and one may be non-ambulatory and is currently operating at full capacity. Physical Plant: The facility is a single story home located at 328 Melbourne Glen, Escondido, CA, and the land- line phone number is (858)-205-1586, and is operable. The LPA observed the resident's bedrooms, and they are equipped with required furniture as per Title 22. The LPA inspected the facility bathroom, and the hot water temperature tested within regulations. The bathrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and three fire extinguishers, and a first aid kit with manual. The LPA observed required postings such as; the Ombudsman poster, "If you See Something, Say Something" and the "Personal Rights" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the resident. There was a designated space for the resident and staff files. Medications: The medications were, locked, and inaccessible to the residents. The overall facility is clean, and the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there were a variety of food types. Dishes and utensils are in sufficient supply and stored properly. Care & Supervision: The facility has sufficient staff, two staff at the time of this visit, and the staff were attentive and engaging the residents. Records Review: The LPA reviewed six resident files, three staff files. There were no Title 22, Division 6 Regulation violations observed and/or cited during todays visit. An exit interview was conducted and a copy of this report was given to the Administrator, William Lee.the state’s words, verbatim · CDSS document, Nov 7, 2023