Indian Peak Manor

Type of visit: Annual/Random

On 08/31/26, the department conducted an unannounced 1-year required annual visit to the above-named facility. The department met with Administrator, Glenda Marquez, and the purpose of the visit was explained. The department was granted entry to the facility. The facility is licensed to serve residents 60 years and above. The capacity is for six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has a hospice waiver for two (2) residents. Currently, the home has five (5) residents. The facilities annual fees are current. The facility is a single story home located in a residential neighborhood, and it consists of the following: four (4) bedrooms, two (2) bathrooms, kitchen, living room, dining area, laundry area, an attached garage, and outside shaded area. Outside grounds were toured and no bodies of water were observed. Patio furniture under a shaded area was accessible to clients. There are no security bars or weapons on the premises. All resident bedrooms were checked. Beds and beddings were in good condition, adequate lighting provided, adequate storage for resident’s personal belongings was observed. Walls and floors were clean and in good condition. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Bathroom toilets and water faucets worked properly. The shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible for resident’s use. Continued on LIC809-C The water temperature properly measured between 105.0-120.0 degrees Fahrenheit. A comfortable temperature is maintained in the facility. Storage areas for cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected, and there is enough perishable and non-perishable food available for the residents. All food items were stored properly. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked, along with manual. Smoke and carbon monoxide detectors were operable. Fire extinguishers were fully charged. Toxins and knives were locked and inaccessible to residents. The department conducted a review of four (4) staff records and observed them to be complete, and five (5) client records, and observed them to be complete, in order, and with no discrepancies. During the visit, the department observed the facility infection control practices. The department observed screening protocols for visitors, staff, and residents. The department observed sanitizing stations were in common areas and restrooms. The department observed that the facility had the required postings posted as mandated throughout the facility. Last fire drill was conducted on 08/15/26. Active Administrator certificate for Glenda Marquez, #7001021740, effective 05/15/25, expires 05/14/27. Liability Insurance with Perlas Insurance Services, Policy #01004460160, effective 04/21/26, expires 04/21/27. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during today’s visit will be documented on LIC809-D An exit interview was conducted and a copy of this report was discussed and left with Glenda Marquez. * Please note that due to technical difficulties, the department was unable to generate an electronic inspection tool and instead used a printable/PDF version.the state’s words, verbatim · CDSS document, Aug 31, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(c)(1) · Plan of correction due date: Sep 14, 2026

87458(c): The medical assessment shall include, but not be limited to: (1): A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above. LPA identified that Residents #1, and #4 did not have a current Medical Assessment, LIC 602A. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 31, 2026

Plan of correction: Licensee will ensure that proper annual Medical Assessment LIC 602A for all residents in care. Licensee will provide current medical assessment, LIC 602A for resident #1, and #4. Proof of correction must be sent to LPA elvira.gonzalez@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR87456(a)(2) · Plan of correction due date: Sep 14, 2026

87456(a): Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2): Perform a pre-admission appraisal. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above. LPA identified no Needs Service Plan Appraisal for Resident #1, #2, #3, and #4. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 31, 2026

Plan of correction: Licensee will adhere to Title 22 Reg 87456(a)(2). Licensee will ensure all residents in care must have Needs Service Plan/Appraisal on file. Proof of correction must be sent to LPA elvira.gonzalez@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 14, 2026

87303 Maintenance and Operation (a): The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: This deficiency was not met as LPA observed live cockroaches in facility kitchen cabinets, on the kitchen table, and on the living room floor, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2026

Plan of correction: Licensee/Administrator to submit plan, including pest control receipts, to LPA by POC due date detailing what the facility is going to do regarding pest control throughout the facility. What measure will be added to cleaning procedures to ensure pests at the facility is under control to ensure residents’ health and safety. Proof of correction must be sent to LPA Elvira.gonzalez@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(d)(6) · Plan of correction due date: Sep 14, 2026

87307(d): The following space and safety provisions shall apply to all facilities: (6): All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as the backyard was full of boxes, shoes, clothing, clutter, and old/unused items, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 31, 2026

Plan of correction: Licensee/Administrator will send LPA pictures once items have been removed, and cleared, and remind staff to keep outside, passageways, clear and remove anything that may be a tripping hazard to residents. Proof of correction must be sent to LPA Elvira.gonzalez@dss.ca.gov

Allegation investigated: Staff did not prevent inappropriate sexual interation between clients in care

On 05/15/26 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent complaint visit at the facility. California Department of Social Services (CDSS) was met by staff two, Joseph Medina - Caregiver (S2), and the purpose of the visit was explained. The investigation consisted of the following: On 01/30/26 LPA Calderon obtained the following records: The Physician report (dated 05/25/2025), the Preplacement Appraisal plan (dated 03/17/2025), VA hospital (dated 01/29/2026), Admission Agreement (dated 02/24/2015) of R1. CDSS toured the facility with Glenda Marquez (S1) and did not see any negative interaction between residents. On 05/15/26 CDSS was met by Joseph Medina (S2), and requested resident list (Dated 07/03/2025) and physician's report of R2 (dated 03/20/2026). CDSS interviewed four (4) residents (R1-R4), three (3) staff (S1-S3) and witness one (W1). The investigation revealed the following: Regarding the allegation, “Staff did not prevent inappropriate sexual interation between clients in care.”, it is being alleged that approximately 5 to 10 years ago, a resident (R1) was molested by their roommate at the facility. Report continues, please see LIC9099-C. Unsubstantiated Record reviews revealed the following: R1's secondary diagnosis has been marked as schizophrenia with other condition marked as bipolar disorder. Between 09:00AM and 11:15AM, LPA interviewed three (3) residents (R1 & R3-R4) and three (3) staff (S1-S3). R2 was not available for interview due to their medical condition. Interviews revealed the following: Interviews revealed that two (2) out of three (3) residents and all three (3) staff, along with witness one (W1), have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with Joseph Medina (S2) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, May 15, 2026 · control 11-AS-20260127171627

Type of visit: Required - 1 Year

On 08/11/25, at 9:20am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required inspection visit to Indian Peak Manor. LPA met with Ricardo De La Torre, Licensee, and Glenda Marquez, Administrator, and explained the purpose of today’s visit. The facility is licensed to serve (6) residents ages 60 and over, six (6) non-ambulatory, of which one (1) may be bedridden. Hospice waiver for two (2). Currently, the home has (5) residents. The facilities annual fees are current. The facility is a single-story residential home located in a residential neighborhood. The home consists of the following: 4 bedrooms, 2 bathrooms, kitchen, living room, dining area, laundry area, attached garage, and a backyard. LPA conducted a records review of (5) resident records, (5) staff records, and reviewed the facilities emergency disaster plan. All resident and staff records were complete. The facility emergency disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (5) resident medication administration records and medication, and did not observe any discrepancies at the time of visit. At 9:30am, LPA and staff toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, and adequate storage for resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. Report Continued on LIC809-C The shower was free of mold/mildew, and there were sufficient toiletries to meet the needs of the residents. The water temperature was within Title 22 regulations of 105.0F degrees and 120.0F degrees in the kitchen and the bathroom; a comfortable temperature is maintained in the facility. LPA observed storage areas for cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there is enough perishable and non-perishable food available for the residents. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked with manual. The fire extinguisher was charged and last serviced on 12/23/2024. The smoke/carbon monoxide detectors were operable. The last fire/emergency drill was conducted on 06/15/2025. The facilities administrator has a pending renewal certification application which was received on 05/14/2025. The facilities liability insurance was valid from 04/13/2025 through 4/13/2026. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that sanitizing stations were in common areas and restrooms. LPA observed that the facility had the required postings, posted throughout the facility. LPA advised the facility to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues. No deficiencies were cited during this inspection visit. An exit interview was conducted, and a copy of this Facility Evaluation Report was provided to Glenda Marquez, Administrator.the state’s words, verbatim · CDSS document, Aug 11, 2025

Type of visit: Required - 1 Year

On 07/03/2024 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced, Required Annual, inspection and met with Licensee Ricardo DeLa Torre and later by Glenda Marquez, Administrator. Six (6) residents and two (2) staff were present during this inspection. The above-mentioned facility is licensed to serve six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility has a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of four (4) bedrooms, two (2) full bathrooms, shaded back yard, front yard, and a laundry room in the attached two (2) car garage. Administrator Marquez accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. The screen in room four (4) needs to be replaced.Resident bathrooms were checked. Toilets and water faucets worked properly, yet both sinks in bathroom number two (#2) were clogged. Grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Hot water temperature properly measured at 110.3 degrees F which is within title 22 regulations. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked during today's visit. Common areas were clean and clear of hazards, doorways were free of obstructions and a comfortable indoor temperature was maintained at 76.1 degrees F. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food, all stored properly with dates tagged on each storage bag. Knives and potentially dangerous toxins were kept in locked storage cabinet. First-Aid kit was available, with handbook, properly maintained. Two fire extinguishers were observed. One (1) in the kitchen and one (1) in the garage. Both extinguishers were fully charged, last serviced December 09, 2023. LPA tested carbon monoxide detectors and smoke detectors. All devices were connected and functional. LPA observed all medications were centrally stored and inaccessible to residents in care. Report continues, see LIC809C. LPA conducted record reviews which included six (6) residents (R1-R6) service records and two (2) (S1-S2) personnel records and all was observed to be maintained in order and complete. LPA observed all documents are posted as mandated and the last emergency drill was conducted on 06/14/2024. LPA observed required liability insurance is being maintained, from 04/13/2024 through 04/13/2025. During today's visit, there were two (2) deficiencies cited. Please see LIC809D. During today's visit, there were two (2) advisory notes (AN). One AN marked as a technical violation (TV) and the second (2nd) marked as technical assistance (TA) An exit interview was held with Glenda Marquez, Administrator, and a copy of the facilities' appeal rights, deficiencies, AN's and this report were provided.the state’s words, verbatim · CDSS document, Jul 3, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 12/21/2023 at 9:56 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with Administrator Glenda Marquez. Six (6) residents and two (2) staff were present during this inspection. Facility is licensed to serve six (6) non-ambulatory, of which one (1) may be bedridden. The facility has a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists (4) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room in the attached 2 garage.. Administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 107.2 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. Two fire extinguishers, last serviced December 9, 2023 was observed in the kitchen and garage area. LPA tested all carbon monoxide detectors and smoke detector. Both devices were functional. Continue to LIC-809C 5 staff records were reviewed, 5 out of 5 staff records had required criminal record clearances or criminal record exemptions. Two staff interviews were conducted. 5 resident records were reviewed and two residents’ medication was reviewed. Two residents were interviewed. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. During record review, LPA did not observe annual medical assessments and reappraisals for three residents diagnosed with dementia. During record review, LPA did not observe that the Administrator’s recertification requirements were met. An exit interview was conducted, plans of corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with Glenda Marquez.the state’s words, verbatim · CDSS document, Dec 21, 2023

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff does not ensure that facility is maintained clean and sanitary. Facility is in disrepair.

On 10/4/2023 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez meet with Glenda Marquez/Administrator. LPA explained the purpose of this visit. Investigation Consisted of: LPA conducted an entire physical tour of the facility and photographs. Evaluation Report continues LIC 9099-C Investigation Revealed the Following: Substantiated Investigation Revealed the Following: Allegation: Staff does not ensure that facility is free of odors. During the physical tour, LPA conducted an entire facility tour with the administrator; LPA did not notice or smell foul odors in the common areas or resident rooms. In addition, when LPA arrived at the facility on 10/5/2023 at approximately 9:30 AM, he observed A#1 and S#1 mopping and cleaning the facility floors with cleaning and disinfecting supplies. During an interview with the administrator(A#1), she stated that she and S#1 mop the floors and clean the surfaces with cleaning and disinfecting products daily (5 times daily) and as needed. In addition, A#1 stated that to prevent odors, she and S#1 clean the facility floors, restrooms, residents’ rooms, kitchen, and other surfaces daily and as needed. During an interview with staff(S#1), he stated that the facility is clean and does not have foul odors. During interviews with residents (R#1-R#4), 4 out of 4 stated that the facility is clean, sanitary, and does not have foul odors or smells. In addition, 4 out of 4 residents stated that the facility staff regularly cleans the facility. Allegation: Staff do not ensure that residents' hygiene needs are being met. During the records review, LPA observed the following: (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly/LIC 602. In the case of (R#1 and R#2), both can bathe, dress and groom themselves. For (R#3 and R#4) both residents need assistance with bathing, dressing, and grooming. In addition, LPA reviewed (R#1-R#4) the Admissions Agreement; it is stated that these items are included as basic service: Basic hygiene items such as soap and toilet paper, weekly linen changing, and laundry service. Evaluation Report continues LIC 9099-C During an interview with the administrator(A#1), she stated that every day, there are two staff members, including her, tending to the needs of the residents, and on the weekends, there are three staff. In addition, (A#1) stated that the hygiene needs of the residents are being met by the facility, which follows a weekly bathing schedule and as needed. During an interview with staff(S#1), he stated that the facility is meeting the hygiene needs of the residents, and they bathe them every day and as needed in case of incontinence problems. During interviews with residents (R#1-R#4), 4 out of 4 stated that the facility meets their hygiene needs and takes showers or baths daily or when needed. During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted, and a copy of the Complaint Report was given to Glenda Marquez /Administrator. Allegation: Staff does not ensure that facility is maintained clean and sanitary. The details of the complaint alleged that the facility is not clean and sanitary. During the physical tour, LPA and the administrator toured the entire facility; while touring the facility, LPA observed dog feces in one of the bathrooms used by the residents. LPA proceeded to take a photo as evidence of the investigation. The administrator cleaned the feces at that moment. In addition, while touring the back patio, LPA observed cluttered items that could be a potential fall hazard for residents. LPA proceeded to take a photo of these items as evidence of the investigation. Also, LPA observed five small dogs and a dog playpen inside one of the resident rooms; LPA asked the administrator who is the owner of the dogs. The administrator replied: "There are mine." LPA took a picture as evidence. During the records review, LPA looked at the Facility Program Description in the facility's physical file. The facility does not have pets or therapy pets included in the program. LPA consulted with LPM regarding the dogs, LPM stated that if the facility wants to keep the dogs, they need to submit an addendum to their Admissions Agreement, an addendum to the Plan of Operations, a signature of all residents and their representatives stating that they are okay with the dogs being inside the facility and all dogs must be licensed and with their current shoots. Allegation: Facility is in disrepair. The details of the complaint alleged that the facility is in disrepair. During the physical tour, LPA Iniguez and the Administrator toured the entire facility; LPA found a shattered window panel from the resident's closet in one of the residents' rooms. Also, LPA observed rust in the railing of closet doors in 3 residents' bedrooms. LPA proceeded to take pictures as part of the investigation. Evaluation Report continues LIC 9099-C During this investigation, LPA found sufficient evidence to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D. An exit interview was conducted, and a copy of the Complaint Report was given to Glenda Marquez/Administrator.the state’s words, verbatim · CDSS document, Oct 5, 2023 · control 11-AS-20230811130350

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 2, 2023

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: Based on observations and photographs, the licensee failed to keep the facility in good repair at all times, having a broken mirror door closet in one of the resident's rooms and rusted closet railings in 3 residents' rooms. This poses a potential health and safety risk to all residents in care.the state’s words, verbatim · CDSS document, Oct 5, 2023

Plan of correction: The licensee will replace the broken door and rusted railing before the POC due date. Proof of correction must be emailed to LPA before the due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(1) · Plan of correction due date: Nov 2, 2023

87208 Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (1) Statement of purposes and program goals. This requirement was not met as evidence by: Based on observation and records review, the licensee failed to follow the original facility's Plan of Operations and Admissions Agreement in having four small dogs living inside the facility. This poses a potential health and safety risk to all residents in care.the state’s words, verbatim · CDSS document, Oct 5, 2023

Plan of correction: The licensee will submit an addendum to their Admissions Agreement, Plan of Operations, a signature of all residents and their representatives stating that they are okay with the dogs being inside the facility and all dogs must be licensed and with their current shoots as POC. Proof of correction must be email to LPA before POC due date.