Genesis Manor VI

Type of visit: Case Management - Health Checks

On 04/29/2026, Licensing Program Analysts (LPAs) LaVette Farlow and Renese Howell-Small conducted an unannounced visit to the facility for the purpose of a Case Management visit - health and safety check concerning the deficiency cited from the annual inspection completed on 2/5/2026. LPA Farlow and Howell-Small identified themselves to Caregiver, Marlon D. Ferreira, and discussed the purpose of the visit. Caregiver Marlon notified Administrator, Marya Alpert of LPAs arrival and the purpose of the visit. LPA Farlow spoke to Marya on the phone and provided further details of the visit. No imminent health and/or safety concerns observed at the time of visit. LPA observed no health and/or safety hazards inside the facility. LPAs inspected the inside and outside perimeter of the facility and observed no health and/or safety hazards. LPAs observed sufficient staff present at the facility to provide care. LPAs inspected the facility dining and kitchen area and found it to be clean, sanitized and in order. LPA was able to verify that current census is six (6) residents and zero (0) residents are bedridden. The needs of the residents in care appear to be met as observed during this inspection. During the visit ,sister and Administrator of Genesis Manor, Alaina Hendrick arrived to assist with any questions or concerns. LPA Farlow advised to increase the bedridden status the following process needs to be completed. Review Regulation 87606 Care of Bedridden Residents. Review Regulation 87212 Emergency Disaster Plan. Review and Update the LIC 610E. Complete the LIC200 application and submit. Complete a Fire Clearance STD850. Update the Facility Sketch. Create a Plan of Operation for an increase for Care of Bedridden Residents. An exit interview was conducted where this report (LIC809) was discussed and a copy provided to Alaina Hendrick, Administrator.the state’s words, verbatim · CDSS document, Apr 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs), LaVette Farlow and Michelle Echeverria arrived at the Genesis Manor VI facility unannounced to conduct the Annual Inspection. LPAs was greeted by Caregiver, Marietta Tecson and invited inside. Caregiver Mariette contacted the Administrator, Marya Alpert, who arrived later during the visit. Also, during the two other representative arrived during the visit Elyssa Kimble, and Alaina Hendricks. The facility is a residential Home comprised of 6 bedrooms, 2 bathrooms, kitchen, dining room, backyard and attached garage, and staff living quarters. LPAs conducted a general inspection, which include, but was not limited to the following: Physical Plant - The facility is approved for six, (6) non-ambulatory residents, 1 of which may be bedridden. There is a Hospice Waiver in place for three (3) residents. The current census is 5. LPAs reviewed residents files, toured the facility, and reviewed the facility sketch. LPAs observed two residents who are bedridden who were not in the designated bedridden approved bedroom. Fire clearance and Community Care License (CCL) granted a license for only one bedridden resident in room #6 that has an emergency exit to the backyard. Deficiencies with civil penalties cited. The facility is maintained in comfortable temperature. Interior pathways were free of clutter. LPA inspected 5 resident rooms, and one bedroom was under construction and was unable to be inspected. Each room included all required furniture such as sufficient storage space, lighting, mattress with proper linens, night stands, in tact windows and seating. Please see LIC809-C There are 2 bathrooms. LPAs were only able to inspect one resident bathroom due to construction being completed on the bedroom #4 with a bathroom inside. LPAs tested the water temperature in the bathroom and kitchen. During the LPAs initial testing, the water measured at 134.5 and 136.6. LPAs were asked to conduct a retest with Elyssa. During the retest the water measured at 126.9 and Elyssa asked to aim it at a different position of the water flow and the measurement kept rising. Elyssa did not allow the measurement to be completed. Elyssa stated when she tested the water, it measured 119-122 Fahrenheit. Deficiency cited. The bathroom was equipped with handrails, non-slip grip materials, and adequate amounts of hand hygiene & paper supplies. LPAs observed cleaning supplies under the bathroom sink such as Ajax, and a liquid cleaning solution. LPAs advised Caregiver to remove and secure the supplies. A Deficiency cited. LPAs observed fully charged fire extinguishers throughout the facility is also equipped with operable fire and carbon monoxide alarms. Administrator, reported the facility conducts fire/disaster drills on a monthly basis. Last drill conducted December 2025. Near the front entrance of the facility, LPAs observed posters for Infection Control, Resident/Personal Rights, Emergency Contact Info. Facility Sketches with Evacuation Routes, Facility Roster, LTC Ombudsman and the Theft & Loss Policy. The facility maintains emergency food supplies and first aid kits readily available to those who may need it. Food Service: LPA observed the facility's food supply, kept in the refrigerator, freezer and 2 pantries. LPA noted milk, bread, eggs, cheese, fresh vegetables, and a variety of frozen food accessible to residents in care. Amounts of food sufficient for the number of residents in care. LPA's observed some expired parmesan cheese and peanut butter in the pantry. A Deficiency cited. LPAs observed a lock on the refrigerator and pantry. LPAs inquired about the cabinet and refrigerator being locked. Administrator stated it was due to a prior resident that wanders at night. Administrator removed the locks from the refrigerator and cabinet/pantry. Sharps and cleaning supplies are maintained securely under the kitchen sink. LPA also observed dishware, cups, and utensils were adequate in amount and properly stored. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. There were three staff members present at the time of LPA's inspection. ***Please LIC-809C*** Record Review: LPA reviewed, three 3 resident files for admission agreements, updated physician reports, and needs and services plans. LPA's observed the Telecommunications Device Notification form was not signed by the resident or residents responsible party. A Technical Violation issued. LPA also reviewed 4 staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. LPA's noticed the Administrator renewal application certificate was submitted in January 2026 which is a month after the Administrator certificate expiration date. A Technical Violation issued. LPA's audit residents medication and observed one (1) out of two (2) residents bubble did not match the number of medication issued to the number of medication in the bubble pack. LPA's observed and interviewed staff. A Deficiency cited. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Based on observations, five (5) Deficiencies, and two (2) Technical Violation cited per Title 22, California Code of Regulations. A copy of this report LIC809, LIC809C, LIC809D, LIC9102TV, LIC421IM and appeal rights were provided to Administrator, Marya Alpert.the state’s words, verbatim · CDSS document, Feb 5, 2026

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with caregiver Marietta Tecson was granted entry to the facility. Licensed capacity is (6) current census (3). LPA was accompanied by caregiver Marietta Tecson 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 resident 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 and carbon monoxide alarms. 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. There was a designated space for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. 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 (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (3) resident medications and (1) hospice files. LPA also reviewed (4) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator David E Markie.the state’s words, verbatim · CDSS document, Feb 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Genesis Manor VI facility unannounced to conduct the Annual Inspection. LPA was greeted by Caregiver, Marietta Tecson and invited inside. Staff Member Alfonsa stated she would contact the Administrator, Marya Alpert, who arrived later during the visit. The facility is a residential Home comprised of 6 bedrooms, 2 bathrooms, kitchen, dining room, backyard and attached garage. LPA conducted a general inspection, which include, but was not limited to the following: Physical Plant - The facility is approved for six, (6) residents, 1 of which may be bedridden. There is a Hospice Waiver in place for three, (3) residents. The current census is 6. The facility is operating in the capacity approved by Community Care Licensing (CCL). The facility is maintained in comfortable temperature. Interior pathways were free of clutter. LPA inspected 6 resident rooms. Each room included all required furniture such as sufficient storage space, lighting, mattress with proper linens, night stands, in tact windows and seating. There are 2 bathrooms. Each bathroom was equipped with handrails, non-slip grip materials, and adequate amounts of hand hygiene & paper supplies. LPA observed 3 fully charged fire extinguishers throughout the facility is also equipped with operable fire and carbon monoxide alarms. Administrator, reported the facility conducts fire/disaster drills on a monthly basis. Last drill conducted December 2023. Near the front entrance of the facility, LPA observed posters for Infection Control, Resident/Personal Rights, Emergency Contact Info. Facility Sketches with Evacuation Routes, Facility Roster, LTC Ombudsman and the Theft & Loss Policy. The facility maintains emergency food supplies and first aid kits readily available to those who may need it. Please see LIC809-C Food Service: LPA observed the facility's food supply, kept in the refrigerator, freezer and 2 pantries. LPA noted milk, bread, eggs, cheese, fresh vegetables, and a variety of frozen food accessible to residents in care. Amounts of food sufficient for the number of residents in care. Sharps and cleaning supplies are maintained securely under the kitchen sink. LPA also observed dishware, cups, and utensils were adequate in amount and properly stored. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. There were four staff members present at the time of LPA's inspection. LPA was provided staff records; LPA observed that staff members files were complete with criminal record statements, fingerprint background clearance through the department. Each staff file included proof of training in Dementia, Medication Management, Sanitation, Infection Control, Mandated Reporting, Hospice, Skin Care, First Aid and CPR, health screenings and Activities of Daily Living. Medications were observed to be kept secure along with the facility files. Record Review: LPA reviewed, three 3 resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed 2 staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Administrator certificates both in good standing. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Based on observations, no deficiencies will be cited per Title 22, California Code of Regulations. A copy of this report was read/reviewed with Licensee; signature acknowledges understanding and receipt of report and attachments.the state’s words, verbatim · CDSS document, Jan 22, 2024