Familycare Cottage IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit today. Upon arrival, the LPA was greeted by staff, who then contacted the Administrator telephonically and informed them of the visit. The Administrator, Marisol Flamenco arrived at approximately 10:10am and the reason for the visit was explained. Entrance interview conducted. Records: Record review began at approximately 10:00am. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, preplacement appraisals, appraisals, and current needs and services plan. All files were in order. Five (5) personnel files were reviewed for, but not limited to: personnel records, health assessments with negative TB test results, criminal record clearances, first aid/CPR training, and the appropriate yearly training. Although the facility had a designate training binder, the LPA was unable to determine the number of hours completed per regulation for the past 12 months. All other files were complete. Emergency Disaster Planning: During today’s visit, the LPA reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Report Continued on LIC 809C... Report Continued from LIC 809... Emergency disaster drills conducted quarterly as per regulation; last disaster drill conducted on 05/12/2026. Beginning at 12:25pm, the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: Kitchen: The LPA inspected the kitchen/food service area at approximately 12:40pm. Knives and sharps were observed in a locked cabinet at the time of the visit. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. At 12:41pm, the water temperature was checked in the kitchen sink, and it read 113.7 degrees Fahrenheit. Bedrooms: There are six (6) bedrooms for resident use. All six (6) bedrooms are designated as private / single bedrooms. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Additional clean linens and towels were available for residents in care in a closet by the main hallway. Restrooms: There are four (4) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with non-skid surfaces and grab bars. The bathrooms were observed to be sufficiently stocked with necessary supplies. Starting at 12:28pm, the hot water temperature was measured in resident bathrooms, and they measured between 105 and 120 degrees Fahrenheit, which is within the required range. Personal hygiene items were observed inaccessible to residents at the time of the visit. Common Areas: This includes the living room and dining room area. Furniture in the common areas was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. Report Continued on LIC 809C... Report Continued from LIC 809C... The LPA observed a fire extinguisher to be fully charged with a purchase date of 07/09/2026. Required postings were observed throughout the common space. There is a working telephone on premises. The LPA observed a fireplace in the living room; adequately screened. Cameras were observed in common areas. No hazards/obstructions observed inside or out. Garage: The house has direct access to the garage through the kitchen. Washer and dryer were observed inside the garage. Detergents and cleaning supplies were observed inaccessible to residents in care at the time of the visit. There is another refrigerator and freezer in the garage with additional food. A sufficient supply of emergency food and water was observed. Outdoors: The backyard has a covered patio area with adequate furniture for resident use. Emergency passageway was observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms for emergency purposes. No bodies of water noted at the time of the visit. Medications: Medication review began at approximately 01:00pm. Medications are centrally stored and kept in a locked cart by the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRN Authorization letters are on file. First aid kit was observed to be complete with manual. Medications appear to be administered as prescribed at the time of the visit. No citations issued at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jul 16, 2026

Allegation investigated: Licensee did not provide responsible party with a refund as required.

Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegation. Upon arrival, LPA met with Administrator Assistant Magdalena "Maggie" Garcia and was explained the reason for the visit. Licensee Debra Bryant arrived at approximately 10:30a.m. Entrance interview conducted. On 02/11/2026, the Department received a complaint alleging that “Licensee did not provide responsible party with a refund as required.” During today's visit, the LPA interviewed the Administrator Assistant (AA), Licensee and obtained a copy of the facilities current client roster which per the AA has been the same roster since 09/22/2025 . Interview with the AA and Licensee revealed that Resident 1, whom the complaint is in reference did not reside at this facility. Based on the information obtained, the allegations are deemed UNFOUNDED at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.Exit interview conducted. A copy of the report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Feb 12, 2026 · control 29-AS-20260211142140

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:30 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator, Marisol Flamenco arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 10:11 a.m., hardwire combination of smoke / carbon monoxide detector and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 07/22/2024 with a new one purchased on 07/17/2025.The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 05/13/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. INTERVIEWS: Starting at 9:50 a.m. LPA conducted one (1) staff and two (2) resident interviews. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809... BEDROOMS: There are six (6) total bedrooms in the facility; all six (6) bedrooms are designated as private, single occupancy, resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: There are five (5) bathrooms. Three (3) are designated as shared / common bathrooms and two (2) are designated as private resident bathrooms. Resident bathrooms were observed to be equipped with slip resistant flooring / mats. Grab bars were observed in the bathrooms. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured all resident bathrooms and ranged between 105-120 degrees Fahrenheit, all within the required range. KITCHEN: The LPA inspected the kitchen/food service area at 10:05 a.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.1 degrees Fahrenheit at 10:07 a.m. Cleaning supplies and other chemicals are kept locked in the garage inaccessible to residents in care. LPA observed an adequate amount of emergency food and water. The garage door is accessible through the kitchen and kept locked at all times. Adjacent to the garage door entrance is where the medication cart is located. BACKYARD: The entire property is fenced. The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. GARAGE: The garage is accessible through the kitchen and kept locked at all times. The garage contains an additional refrigerator and freezer with perishable food items that were checked for proper labels and expiration dates. Additional nonperishable food was observed along with emergency food and water. Cleaning supplies and disinfectants are stored in the locked garage. The laundry area is located in the locked garage. All laundry supplies are locked and inaccessible to residents in care. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... INFECTION CONTROL / EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control and emergency planning are satisfactory. RECORDS: Record review began at approx. 10:15 a.m. Resident Records were reviewed beginning at 10:15 a.m. and Personnel Records at 11:40 a.m. five (5) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan and PRN Authorization letters. Two (2) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. MEDICATIONS: Medications review began at approximately 12:53 p.m. The medications are in a locked medication cart adjacent to the kitchen. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: LPA obtained the following documents - Resident Roster - LIC 9020, Staff Roster - LIC 500, a copy of the Limited Liability insurance, and LIC-9282 Infection Control Plan. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 17, 2025

Allegation investigated: Licensee does not ensure facility is adequately staffed to meet resident's needs Staff are not properly supervising residents who may be a fall risk Staff did not prevent resident from wandering from facility

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegations listed above. LPA arrived at the facility at 09:59AM and initially met with facility staff. LPA indicated the reason for today's visit. Facility Designee Marisol Flamenco arrived shortly after the visit began. Entrance interview conducted. During today's visit, LPA interviewed staff and residents between 10:02AM and 10:40AM and resident's family members at 11:03AM and 11:28AM. LPA also reviewed the current staff schedule. During an initial complaint visit conducted on 12/17/2024, LPA interviewed Designee at 12:10PM, toured the facility with Designee at 12:29PM, LPA took photographs of relevant areas, interviewed staff at 12:33PM, and LPA reviewed and obtained copies of pertinent documents. The following was then determined: Continued on LIC 9099-C Unsubstantiated Allegation: "Licensee does not ensure facility is adequately staffed to meet residents' needs:" LPA interviewed staff, residents, and family members and reviewed staff schedules related to this allegation. LPA noted that 1 (one) staff is scheduled for this facility at all times. Interview with staff revealed that during times when residents require showering, an additional staff comes from another of the licensee's facilities nearby and will assist the staff at this location. It was also noted that the licensee's office is located on this facility property, so during normal business hours Monday through Friday, the facility designee is present at this facility. Staff interviewed stated that either the facility designee or staff from the other facility cover breaks and assist in the facility as needed. Interview also revealed that when a new resident moves in, there are 2 (two) staff scheduled. Additionally, if a new resident moves in that has higher needs or behavioral expressions, the staff schedule is adjusted to meet resident needs. Interview revealed that the residents that reside at the facility at this time do not have unsafe wandering behaviors. Residents interviewed stated there is enough staff at the facility to meet their needs. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Allegation: "Staff are not properly supervising residents who may be a fall risk:" The complaint alleges that during an undisclosed time, while staff was assisting a resident, another resident fell. LPA inquired with staff, residents, and facility designee related to falls. All persons interviewed stated there have been no falls at this location in some time. During both the initial visit and the subsequent visit, LPA observed residents in the facility to be seated in common areas or in their own rooms. LPA also observed residents self-ambulating during both visits. Staff indicated that 3 (three) of the 4 (four) residents are able to ambulate safely independently. 1 (one) resident does require an escort while ambulating, but staff are able to assist this resident. Additionally, the resident does have a motion alarm which alerts staff when the resident stands up to ensure this resident is assisted as needed. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Continued on LIC 9099-C Allegation: "Staff did not prevent resident from wandering from facility:" The complaint alleges that a resident wandered out the front door while the staff was busy assisting another resident. LPA interviewed staff and facility designee, all of whom stated there are no current residents who engage in unsafe wandering. Staff stated there was a resident a long time ago that did attempt to elope from the facility, but that the facility designee did accompany the resident out the front door into the facility driveway before redirecting the resident inside. The resident was supervised at all times. LPA noted that the facility does have an auditory alarm on all exit doors, which were observed to be functional during both visits. Staff interviewed indicated that at times when they have had a resident that engages in unsafe wandering, there have been 2 (two) staff scheduled to ensure adequate supervision for the residents in care. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. No citations issued. Exit interview conducted with facility designee. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2025 · control 29-AS-20241211092619

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual visit. The LPA was greeted by staff and Administrator Marisol Flamenco. Reason for the visit was explained. At approximately 11:45am, The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was fully charged and was last purchased on . The LPA observed required postings throughout the common space. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are five designated resident rooms. There was a linen closet in the hallway with extra towels and linens. RESTROOMS: The four resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature is maintained between 105-120 degrees Fahrenheit. KITCHEN: Kitchen/food service area observed clean and sanitary. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for use and is single-latched. No bodies of water noted. The garage is where the washer and dryer are held, including additional perishable food items. Cleaning supplies and disinfectants observed in the garage. The garage was accessible (not locked) during todays visit. Administrator immediately had all laundry supplies, cleaning and disinfecting supplies locked in the cabinet in the garage. Continued on LIC 809-C. RECORDS: Residents’ records review began at 1p.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. MEDICATIONS: Medications review began at 2p.m.; medications are centrally stored and locked in a medication cabinet in the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. PRN Authorization letter not on file for residents with PRN medication. According to Administrator all resident with PRN medication can clearly state symptoms. Administrator was informed that the resident's physician needs to make that determination (on the PRN Authorization letter) and should be kept on file at the facility. Personnel records were reviewed at approximately 3p.m. for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.the state’s words, verbatim · CDSS document, Jul 22, 2024

The state marks this report as 11 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Medication is not being administered as prescribed.

At 9:35 a.m. Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegation. Upon arrival, LPA met with staff Josefina Jimenez Galindo and was explained the reason for the visit. Licensee Debra Bryant arrived shortly. Entrance interview conducted. During today's inspection, between 9:40 a.m. and 1:30 p.m., the LPA interviewed the Licensee, two staff, conducted a medication audit, and obtained copies of resident records and other pertinent documents relevant to the investigation. Report will continue on LIC9099-C. Unsubstantiated On the allegation that the “Medication is not being administered as prescribed”, it is the RP’s concern that a staff member (S1) has been stealing Norco medication from residents. To investigate the allegation, LPA Cortez interviewed the Licensee, staff and conducted a medication audit for all six (6) residents. Licensee and staff interviews revealed that there was a recent incident of missing Norco medications possibly involving S1, however it occurred in a different facility owned by the Licensee and has been reported to Community Care Licensing. Staff interviews also revealed that they have not seen any staff steal medications from residents, do not have any concerns of residents not being administered their prescribed medications, and that S1 no longer works at this facility. At 11:00 a,m, the LPA conducted a medication audit and reviewed the Centrally Stored Medication and Destruction Record (CSMDR), the Medication Administrative Records (MAR) along with the medications in their bubble packs/bottles for the month of January of this year. LPA's record review of all six (6) residents' MAR, CSMDR, and medications revealed each resident was administered their medications as prescribed from 1/1/2024 to present, at this time. Based on interviews conducted, and medication audit, the department does not have sufficient evidence to determine that Medication is not being administered as prescribed. Therefore, the above allegation is deemed UNSUBSTANTIATED at this timethe state’s words, verbatim · CDSS document, Jan 18, 2024 · control 29-AS-20240110170313