Heritage Place

Type of visit: Required - 1 Year

On 08/12/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced prelicensing inspection. LPA met with administrator Villarose Gratuito and new licensee Katie Eiseman and Thomas Eiseman during today's visit. LPA explained the purpose of today's visit. LPA was allowed entry into the facility. This is a single level facility approved all residents to be non-amblatory and 6 hospice residents. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. There are no hospice residents at this time. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the facility stove. Medications are observed to be locked in a closet with the first aid kit near the dining room. First aid kit is observed as complete with required items. Perishable and non-perishable food items are observed as in place. There are additional refrigerator and freezer in the garage area which also carry additional food supplies. LPA observed that there are multiple fire extinguishers in place inspected 08/2024, smoke detector, carbon monoxide detectors are observed in place through out the facility, and central heating/cooling system. The facility has a full fire sprinkler system through out the facility. PPE and additional food supplies are observed as in place. Laundry area is also observed as fully operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 06/24/2025. Water temperature was measured at 115F in the common full bathroom in the main hallway connecting to the resident rooms. Continued on next page... Page 2 LPA observed rooms numerous resident rooms and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Residents on the the left side of the hallway have shared half baths. Resident linen supplies are observed as in place in the laundry room. Cleaning supplies are also observed as locked inaccessible to residents in care beneath the kitchen sink and garage. There is a staff room connected to the living room. Administrator certificate is observed as expiring April 2026. Files are reviewed for 8 out of 10 residents. All are current. Files for 4 staff are reviewed as well and all are current. Report is reviewed with the administrator and licensee a copy is provided on this day.the state’s words, verbatim · CDSS document, Aug 12, 2025

Type of visit: Case Management - Other

On /09/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - other visit to prelicense the new facility. LPA met with Licensee - Katie Eiseman and administrator Villarose Gratuito. During today's visit LPA conducted a prelicensing inspection and component III. No citations issued. This report is reviewed with licensee and a copy is provided.the state’s words, verbatim · CDSS document, Aug 12, 2025

Allegation investigated: - Staff did not perform a proper assessment of resident - Staff did not meet the needs of the resident

On 09/27/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the allegations received. LPA met with licensee Katie Eiseman and explained the purpose of today's visit. During the investigation LPA conducted interviews and reviewed documentation pertinent to the investigation. Per interviews conducted it was found that the licensee/administrator Katie Eiseman did not conduct an in person assessment of the resident prior to him/her being accepted into the faciilty. The facility relied on the statements and documentation from the skilled nursing facility (SNF) he/she were coming from as their assessment. It was only discussed via telephone/facetime. Part of what was not assessed in person was the funcional capabilities of the resident and ability of self care. The resident had an unwillingness for self care which caused decline in his/her health. The resident was respoinsible for their own care and decisions. Unknown to the facility was the insurance issues of the resident and that it had lapsed without the facilities knowledge which caused issues with medications and home health. Based on LPA interviews and items letters received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D. Report is reviewed with licensee and a copy is provided. Substantiatedthe state’s words, verbatim · CDSS document, Sep 27, 2024 · control 14-AS-20240717101429

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87457(c) · Plan of correction due date: Sep 28, 2024

87457(c) Pre-Admission Appraisal - General (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This regulation has not been met as evidenced by: Based on interviews conducted, the facility did not perform a proper assessment prior to admission of the resident in the facility. The facility relied solely on the information provided by the skilled nursing facility instead of doing their own pre-admission appraisal of the residentthe state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: The administrator will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 9/28/2024. The administrator will provide a copy of the completed preadmission appraisals to CCL by 9/25/2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87459(a)(4) · Plan of correction due date: Sep 28, 2024

87459(a)(4) Functional Capabilities - The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited to: (4) Transferring, including the need for assistance in moving in and out of a bed or chair. This regulation has not been met as evidenced by: Based on interviews conducted, the facility did not assess the functional capabilities of the incoming resident and relied solely on the assessment of the skilled nursing facility in order to accurately assess the functional capabilities of the resident.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: The administrator will develop a plan to ensure compliance and will provide a copy of the plan to CCL by 9/28/2024. The administrator will provide a copy of the completed preadmission appraisals to CCL by 9/25/2024.

Type of visit: Required - 1 Year

On 07/18/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with administrator Villarose Gratuito then later the co-licensee Thomas Eisman arrived and LPA met with him as well. LPA was allowed entry into the facility. This is a single level facility approved all residents to be non-amblatory and 6 hospice residents. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the facility stove. Medications are observed to be locked in a cabinet adjacent to the refrigerator. Perishable and non-perishable food items are observed as in place. There are additional refrigerator and freezer in the garage area which also carry additional food supplies. First aid kit is observed as complete with required items. LPA observed that there are multiple fire extinguishers in place inspected 06/21/2023, smoke detector, carbon monoxide detectors are observed in place through out the facility, and central heating/cooling system. The facility has fire sprinkler system through out the facility. PPE and additional food supplies are observed as in place. Laundry area is also observed as fully operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 01/08/202 which can pose a potential health and safety risks for residents and staff in care. Per administrator they have conducted additional drills but the documentation does not reflect this from happening. Water temperature was measured at 130F in a common resident bathroom in the hallway connecting to resident rooms. This temperature poses an immediate health and safety risk to residents in care. Continued on next page... Page 2 LPA observed rooms numerous resident rooms and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. All resident rooms are equipped with half baths. Resident linen supplies are observed as in place. Cleaning supplies are also observed as locked inaccessible to residents in care. There is a staff room connected to the living room. Facility does not handle resident monies. The following updated forms are requested to be submitted to CCLD by 07/25/2024: • Copy of updated Administrator Certificates • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC400 Affidavit Regarding Client/Resident Cash Resources • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property Citation issued on this day on the attached LIC809D. Report is reviewed with the administrator and a copy is provided on this day.the state’s words, verbatim · CDSS document, Jul 18, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Jul 19, 2024

87303(e)(2) Maintenance and Operation (e)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This regulation has not been met as evidenced by: Based on physical plant tour and water temperature taken in common hallway bathroom, the water temperature was measured at 130F which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 18, 2024

Plan of correction: Facility shall develop a written plan on how to address this regulation and keep a record showing that the water temperature delivered is within regulatory standards at all times.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.695(c) · Plan of correction due date: Jul 25, 2024

§1569.695 Emergency Plans(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is notrequired during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This health and safety code has not been met as evidenced by: Based on documentation reviewed, LPA observed the disaster drill/fire drill log has not been updated since 01/08/2020. Per disucssion with the administrator they have conducted such drills but the docuementation has not been updated. This can pose a potential health and safety risk to residents and staff in care.the state’s words, verbatim · CDSS document, Jul 18, 2024

Plan of correction: Facility shall create a written plan on how to meet this health and safety code section at all times and maintaining the record of such drills accurately.