Inland Senior Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by Caregiver Elsia Calapano, notified them of the purpose for the visit and was allowed to enter the facility to conduct the inspection. The facility manager Eldalin De Deugd arrived at a later time. Facility Overview: The facility is a single story building with five (5) residents bedrooms, 1 staff room, three (3) bathrooms, two common areas, a dining room, a laundry room, a kitchen area and a garage. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen ,inaccessible to resident in care. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers to be in compliance with the department requirements and with an expiration date of February 09, 2027. The water temperature was tested within regulations measuring at 105.9 F Continued 809-C...... Care & Supervision/Administration: Adequate staff were present to supervise the residents during the visit. The Administrator holds a current administrator’s certificate with expiration date of January 22, 2027 and a CPR certification with the expiration date of February, 2027 Record Review and Resident/Staff Files: LPA reviewed files for two (2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three (3) residents' files were reviewed and contained all required documentation. LPA observed first kit to be locked and inaccessible to the residents in care. The residents and staff files were kept in a locked in the hallway and inaccessible to unauthorized individuals. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in the hallway area. LPA reviewed medications for two(2) residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on January 10-2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Facility manager Eldalin De Deugdthe state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Six (6) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. LPA began review of employee records- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued from Page 1) Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 110.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan however there were two (2) non-ambulatory residents observed not in designated non-ambulatory room . Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 12/24/2024. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 01/5/2025. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there are two (2) deficiencies is being cited and Civil Penalties issue for $500 per Title 22, Division 6 of The California Code of Regulations. This report , LIC809D, LIC421IM was reviewed with and a copy provided to the facility representative. Appeal Rights were also provided at the time of the exit interview. LPA has requested updates to the following documents to be submitted to the CCL by 03/28/2025: LIC 308, LIC 500, LIC 610.the state’s words, verbatim · CDSS document, Mar 24, 2025

Type of visit: Office

Licensing Program Manager (LPM) Tricia Danielson and Licensing Program Analyst (LPA) Janette Romero met with Licensee, Teresa Perez at the Riverside Adult and Senior Care Regional Office for the purpose of discussing ongoing concerns with the facility. Below is a summary of what was discussed: Licensee reported they are working with Assisted Living Waiver Program (ALWP) to find more appropriate placement for Resident 1 (R1). Licensee reported ALWP approved and is providing 1:1 care staff for R1 during the hours of 7:00 p.m. to 7:00 a.m until proper placement is found. Licensee reported the facility has one (1) awake night staff on duty at all times. Licensee confirmed understanding that R1 cannot be discharged from the facility via 51/50 hold. An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee Perez.the state’s words, verbatim · CDSS document, Apr 15, 2024

Type of visit: Required - 1 Year

On 3/5/2024, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to conduct a required annual inspection at the facility. LPA was greeted and granted entry by Caregiver, Elsie Calapano who was informed of the purpose of the visit. Licensee, Ma. Teresa Perez arrived during the visit. During today's visit, LPA conducted a tour of the facility's interior and exterior with Caregiver Calapano. During the tour, LPA observed the facility is made up of a one-story home with 5 resident bedrooms, 3 resident bathrooms, a kitchen, dining room and two (2) living rooms. The facility is licensed to care for four (4) ambulatory and two (2) non-ambulatory residents ages 60 and over. The facility also has an approved hospice waiver for six (6) residents and a dementia care plan of operation. During LPA's visit, there was six (6) residents and three (3) staff present. LPA observed residents in their rooms and in common areas of the facility. Licensee tested the smoke alarms/carbon monoxide detectors and LPA found them to be operational. There are two (2) fire extinguishers charged and mounted in the facility, which were serviced on 12/4/2023. LPA observed the facility has a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Resident rooms had the required bedding, furniture and lighting. LPA observed disinfectants and cleaning solutions secured in a bathroom cabinet. Medications are also secured and only accessible to facility staff. Indoor and outdoor passageways are free of obstruction and the physical plant is in good condition. During today's visit, LPA did not issue any deficiencies. An exit interview was conducted where this report was reviewed and provided to Licensee Perez.the state’s words, verbatim · CDSS document, Mar 5, 2024