Hillside Home for Elderly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. Upon arriving at the facility, LPA met with Mariciel Gamboa, Administrator. LPA explained the purpose of the visit. The facility has a capacity of six (6) residents. It is licensed to serve elderly residents age 60 and above, and approved for six (6) non-ambulatory residents. Facility may retain four (4) hospice residents. Facility have 24 hour awake staff. Currently, all six (6) residents are non-ambulatory. Annual fees are current. Administrator certificate is current and expires on August 2025, renewal was sent in July certificate is pending. During the visit, the care tool was used, a tour of the facility was conducted, medication was reviewed, staff was interviewed, residents were interviewed, and food supply was reviewed. The facility is in a residential area. A physical tour was conducted. The facility is a single-story house which includes living room, dining area, attached garage/storage, kitchen, pantry, TV room, four (4) resident bedrooms, two (2) bathrooms and staff office/lounge room. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 105-120 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. There are no pools and bodies of water on the premises. There are no firearms on the premises. Facility maintains a comfortable temperature for residents. (-continued in LIC 809C-) Sufficient supply of perishable and nonperishable foods was observed. Smoke detectors and carbon monoxide detectors are operable. Smoke- detectors in the hallway and bedrooms are hard wired. Fire extinguisher was mounted in the kitchen wall and fully charged. Emergency drill was conducted on 10/01/25. The first aid kit is fully stocked. All mandated documents and signages are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication are centrally stored in a locked storage room and inaccessible to residents. Resident records are stored in a locked storage room and inaccessible to residents. Technical advisory- Medication Administration Records needs updating. No deficiency was observed. An exit interview was conducted. This report is discussed and provided to facility, Administrator Mariciel Gamboa.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met Mariciel Gamboa, Administrator and explained the purpose of the visit. The facility has a capacity of six (6) residents and is licensed to serve elderly residents age 60 and above. The facility was approved for six (6) non-ambulatory residents which may retain four (4) hospice residents. Facility have 24 hour awake staff. Currently, all four (4) residents are non-ambulatory. Annual fees are current. Today's visit, CARE tool was used, a tour of the facility was conducted, medication/facility files were reviewed, staff/residents/food supplies were interviewed. The facility is a single family home, located in a residential area, consisted of living room, dining area, attached garage/storage, kitchen, pantry, TV room, three (3) resident bedrooms, two (2) bathrooms and staff office/lounge room. All rooms were furnished with required furniture. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 117.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Facility maintains a comfortable temperature for residents. Sufficient supply of perishable and nonperishable foods were observed. Smoke detectors and carbon monoxide detectors are operable. Smoke detectors in the hallway and bedrooms are hard wired. Fire extinguisher was mounted in the kitchen wall and fully charged. The outdoor activity area has a shaded patio with ample seating. Medication are centrally stored in a locked storage room and inaccessible to residents. Resident records are stored in a locked storage room and inaccessible to residents. Deficiency was observed and cited in LIC 809D. An exit interview was conducted. LIC 809s report were discussed and provided to facility Administrator.the state’s words, verbatim · CDSS document, Oct 26, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Mariciel Gamboa. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. Infection Control Plan observed. Operational Requirements: A current Plan of Operation observed. Dementia Care Plan Observed A fire clearance for 6 residents of which (6) may be non ambulatory Hospice care waiver approved for up to four (4) resident. Physical Plant/Environment Safety: The facility is a single-story house includes: living room, dining area, attached garage/storage, front and backyard, kitchen, pantry, TV room, three (3) resident bedrooms, two (2) bathrooms and a staff room The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Personnel Records - Staff Training: Administrator on file is current. Staff have criminal background clearance and training. Four (4) staff files were reviewed. Required training observed Continued on LIC 809-C Staffing: Sufficient staff observed during visit Resident Records - Incident Reports: A total of three (3) resident files were reviewed. Resident Rights - Information Required postings observed Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Activities supply observed Food Service: Sanitation practices and kitchen cleanliness was observed. Kitchen has utensils for clients to use and to store their meals Incident Medical and Dental: Emergency transportation available First Aid Kid observed (3) of (3) Resident medications reviewed Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. Last Fire Drill on 10/17/23 Residents with Special Health Needs: Needs and Services Plan and Appraisals are on file. Currently (0) residents receiving hospice services. Inspection Tool was completed and no deficiencies are being cited on todays visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 1, 2023