Granny's Place #4

Type of visit: Required - 1 Year

On today's date January 30,2026 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff. LPA explained the nature of the visit Assistant Administrator Kimberly Arnett and Administrator Michelle Nesbitt were notified via telephone and joined later to assist with the tour. LPA began a tour of the facility and observed the following. This is a one storied home with seven bedrooms one of which is a care giver room, and six of which are resident rooms. Additionally the facility has four and a half bathrooms two of which are private, two of which are shared, and a half bath for staff and guests. Administrator has a valid Administrator certificate posted on the entry way wall that is set to expire on April 11, 2026. There are six residents at the facility and two are receiving hospice. LPA observed the PUB 475 (see something say something) poster and Long-Term Care Ombudsman poster posted at the entry way of the facility. All required department postings were observed to be posted on the entry way walls. LPA observed kitchen area to be clean and free of any mildew or debris. LPA Vanegas observed there to be an electric stove, refrigerator, microwave, washer, dryer, and dishwasher. All tested operational. LPA Vanegas observed there to be a two day supply of perishable food and a seven day supply of non-perishable food on hand at the facility. LPA Vanegas observed a sufficient amount of emergency food and water at the facility. LPA Vanegas observed resident bathrooms to have all required furnishings such as non-skid floor matts, grab bars, and shower chairs. Bathrooms are free of mildew and debris. Water faucets and toilets tested operational. Hot water temperature tested between 103.2 and 105.4 degrees Fahrenheit. CONTINUED ON LIC809-C LPA Vanegas observed client bedrooms to be clean and free of any hazards. LPA observed rooms to have all required furnishings such as a bed, clean linens in good repair; meaning no strains or tares, chest drawers, a reading lamp, and enough storage space to store personal belongings. LPA observed first aid kit to have all required items such as scissors, tweezers, adhesive tape, bandages, a thermometer, and a first aid manual. LPA observed all fire extinguishers to be fully charged and up to date. LPA observed all smoke detectors and carbon monoxide detectors to be operational. LPA observed outside of the facility to have an outdoor shaded seating area. LPA Vanegas observed backyard to be clean and free of any hazards or objects blocking the exit routes. The side gates are self latching and unlocked. LPA reviewed six resident files and four staff files. All files had required documents and annual staff training was up to date and documented. LPA Vanegas reviewed medication administration record (MAR) and medications. Per LPA review medications are being administered per physicians orders. Based on observations made during today's inspection no deficiencies will be issued per title 22 division 6 of the California Code of Regulations. An exit interview was conducted with AD Kimberly Arnett and a copy of this report was provided to the facility and a copy of this report will be mailed to the facility.the state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff and LPA explained the nature of the visit. There are six residents at the facility and there are no residents receiving hospice services currently. LPA accompanied by care staff began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in storage a freezer and a refrigerator in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage closet located in dining room/living room. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the bathroom and LPA measured the hot water temperature which measured 118.9 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink and locked storage cabinet in the garage. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to be private bedrooms and all bedrooms have all the required components. Storage space is provided for residents in their bedroom. Smoke detectors and carbon monoxide detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment. LPA observed that the facility is equipped with solar panels. LPA observed a fire Continued on LIC809-C extinguisher with service date of April 12, 2024, in kitchen and in the hallway lading to the bedrooms. Fire drills are conducted every three months, with the most recent fire drill conducted in December. LPA began review of records. LPA reviewed three resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed four employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility representative and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection for a change of ownership. LPA arrived at the facility and was greeted and granted entry by Compliance Manager (CM) Michelle Nesbitt. An application to operate a Residential Care Facility (RCFE) for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden clients was received by Community Care Licensing (CCL) on 7/18/2023. Structure: The facility is a one-story home with six client resident bedrooms, seven bathrooms, living room, kitchen, dining room, caregiver room, backyard and attached two car garage. There are two exit gates in the back yard. The backyard has a shaded seating area. Client Bedrooms: All resident bedrooms had the necessary furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. Bathrooms: The bathrooms have working plumbing. Hot water measured at 115.3 degrees Fahrenheit, 116.2 degrees Fahrenheit,115.1 degrees Fahrenheit, 109.8 degrees Fahrenheit and 107.4 and 114.3 degrees Fahrenheit. Toxins: LPA observed chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored under the kitchen sink and in the garage. Medications, First-Aid Kit & Files: Medication and first aid kit will be stored in a locked closet near the entryway. Records are digitized and were accessible to LPA during inspection. Fire Extinguisher: LPA observed the fire extinguishers to be fully charged as indicated by the arrow pointing in the green zone. Extinguishers were serviced on 10/4/2023. Fire clearance: Was approved by a fire inspector of Orange County Fire Authority on 8/15/2023. Component III: Information provided about how to operate the facility within compliance and reporting requirements. Activity Materials: The facility has a facility calendar with various outings for residents. Facility also has exercise equipment, music and other electronics, plenty of space to lounge and relax and more. Facility also has a box of activity supplies on site. Linens: A supply of extra linen is stored in the hallway closet. Emergency Phone Numbers, Exit Plan and Menu: Posted and available for review. Food Service: There is 2-day supply of perishable food and a 7-day supply of non-perishable food on hand. Smoke Detectors: Smoke detectors and carbon monoxide detectors were tested and observed to be operational. Appliances: Gas stove, oven, refrigerator, dish washer, microwave, washer, and dryer are operational. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated ADthe state’s words, verbatim · CDSS document, Jan 11, 2024