Graceful Living at Oakdale 3

Type of visit: Required - 1 Year

On 10/30/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived at the facility unannounced to conduct a required 1-year annual inspection. LPA was greeted by a staff member. LPA Lindstrom introduced herself and explained the purpose of the visit. The Care Coordinator arrived at the facility at 1:00 PM and an interview followed. The Care Coordinator joined the LPA on a tour of the facility. The facility is licensed for a capacity of six, including six non-ambulatory only, with a hospice waiver for two. The census at the time of this site visit was five. The Administrator had an Administrator’s Certificate (#7002348740) that wa valid through 12/16/2025. The two Caregivers on duty had criminal background clearances; one of the two caregivers was not associated with the facility. The LPA toured the interior of the facility. The entire facility is clean, orderly, and odor-free. The interior is decorated and filled with natural light. The LPA observed the required postings on the wall near the entry. The living room, dining room, and family room contained adequate seating for residents. The LPA observed three residents in the living room that were reading, watching television, or socializing with family. The bedrooms were clean and contained the required furniture. The windows and window screens were intact. The bathrooms were clean and odor-free. The water temperature in the hallway bathroom was 108 degrees Fahrenheit, which is within the required range of 105 - 120 degrees Fahrenheit. The bathrooms contained grab bars and non-slip mats in the showers. There were extra towels, linens, and supplies in the hallway cabinets. The thermostat was set at 73 degrees Fahrenheit. Staff tested the smoke and carbon monoxide detectors, which were in working order. The fire extinguisher was serviced on 2/19/2025 (Continued on LIC809-D) by Touchdown. The LPA observed logs of quarterly fire drills and an emergency disaster plan that had been reviewed in 2025. The LPA toured the kitchen. The kitchen was clean, orderly, and odor-free. There was a two-day supply of perishable food and seven-day supply of non-perishable food in the refrigerator/freezer and pantry. The LPA observed sharps locked in a kitchen drawer and cleaners locked in a cabinet under the sink. The LPA toured the laundry room. Cleaners and extra toiletries were locked in cabinets in the laundry room. The LPA toured the garage and observed extra food in a chest freezer and refrigerator. The LPA inspected the central medication storage. Medication was stored in locked cabinets in the kitchen, separate from the food. The LPA observed that resident medication was stored in its original containers with intact labels. A first aid kit was located in this cabinet that contained all the required items. The LPA reviewed the paper-based medication administration records (MAR) and found it complete and up-to-date. The LPA inspected the grounds. The backyard was manicured and enclosed by a fence. The walkways were free of obstruction. The LPA reviewed three staff files and five resident files. All staff and resident files were complete. The LPA requested that updated copies of the following documents be submitted to Licensing by 5:00 PM on 11//2025. These documents can be emailed to theLPA at ellen.lindstrom@dss.ca.gov. (1) LIC 308 Designation of Facility Responsibility (2) Copy of a current Administrator Certificate (3) LIC 610 Emergency Disaster Plan (4) Proof of Liability Insurance (5) LIC 500 Personnel Report (6) LIC 309 Administrative Organization (Continued on LIC809-D) As a result of this inspection, a deficiency was cited. The facility was not in compliance with California Code of Regulations (CCR), Title 22, Division 6. The deficiencies are listed on the attached LIC 809D. Failure to correct deficiencies by the noted due date may result in the assessment of civil penalties. An exit interview was conducted with the Care Coordinator, to whom a copy of this LIC809 report, the LIC809D, and the appeals rights was provided. Their signature below confirms receipt of this document.the state’s words, verbatim · CDSS document, Oct 30, 2025

Type of visit: Required - 1 Year

On 11/25/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual visit. LPA Jensen met with Administrator Voica Matis and explained the purpose of today's visit. LPA Jensen toured the grounds which were observed to be well maintained. All paths were free of obstruction. The window screens were in good repair. There is a shaded area and patio furniture for clients to enjoy outdoor activities. The back gate has a self closing latch. LPA Jensen toured the interior and observed the facility to be sanitary and free of odor. There was adequate lighting and furnishings throughout. LPA Jensen inspected the kitchen and observed 2 days of perishable food and 7 days of non-perishable food to be available. There was fresh fruit including apples, bananas, pears and oranges as well as a variety of fresh vegetables. LPA Jensen observed lunch service which consisted of BLT sandwich, fries, juice and ice cream for dessert. LPA Jensen inspected the common areas, bedrooms, laundry room, bathrooms and garage. The water temperature in the bathroom was tested and determined to be within the required range. There are adequate linens available for frequent bedding changes. The fire extinguisher was last serviced in April of 2024 and is in compliance. The carbon monoxide detector was tested and found to be in good working order. The facility maintains first aid kits that are complete. All medications were observed to be locked and inaccessible to residents in care. LPA Jensen reviewed 3 of 3 resident files and both staff files for the care providers that were present on this day. The resident files and staff files were complete and in compliance. The facility has capacity for 6 residents, all of which can be non-ambulatory. There is also a hospice waiver for 2. Currently there are 2 non-ambulatory residents and 1 resident on hospice. The staff present on this day were verified as having criminal background clearance. The facility has a van for transporting residents to appointments if needed. LPA Jensen verified the van has current registration and liability insurance. LPA Jensen and Administrator Voica Matis discussed updates to dementia care that take effect on January 1, 2025. The facility was determined to be in substantial compliance. No deficiencies were observed. An exit interview was conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Nov 25, 2024

Type of visit: Required - 1 Year

On 11/7/23 at approximately 2:20 pm Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual inspection. LPA Jensen met with care coordinator Rainilda Clavano and explained the purpose of today's visit. The Licensee, Voica Matis, holds a current Administrator certificate good through 12/16/2023. The annual fees were verified to be current. LPA Jensen toured the grounds and determined all paths to be free of obstruction. The grounds were observed to be maintained. There is outdoor seating available with shaded areas for client engagement. All screens were in good repair. LPA Jensen toured the interior. The facility was observed to sanitary and was free of odor. There was adequate lighting and furniture throughout. There are night lights available in the hallway. The facility maintains adequate linens and hygiene supplies. All appliances are in good working order. LPA Jensen toured the kitchen and observed in excess of a two day supply of perishable food and a 7 day supply of non-perishable food. There was a variety of fresh fruit and vegetables available. LPA Jensen observed the meal service preparation for dinner which consisted of lasagna, broccoli, and ice cream. LPA Jensen observed a refrigerator in the garage where temperature sensitive medications were stored. The access door to the garage was not locked and morphine was stored in the garage refrigerator. Based on interviews with staff, the door is usually locked and residents do not generally go in the garage. All toxins and sharp objects were locked and inaccessible. The fire extinguisher and carbon monoxide detector were observed to be in compliance. The first aid kit was observed to be complete and in compliance. Regular fire drills are conducted. The facility maintains and an adequate supply of emergency food. The emergency disaster plan has recently been updated and is in compliance. LPA Jensen reviewed 5 of 5 resident files and determined them to be complete. LPA Jensen reviewed 2 staff files and determined them to be complete. LPA Jensen requested and received a current copy of the liability insurance and an LIC 500. All staff present were observed to have criminal back ground clearance and were associated to the facility. LPA Jensen observed residents engaged in various activities including singing and visiting with family members. Deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties. An exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 7, 2023