Integrated Care Communities - A2

Type of visit: Required - 1 Year

On October 31, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Annual Inspection and met with the Licensee, Emely Rodriguez. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for 24 Elderly Adults, and is currently operating at a capacity of 18 Elderly Adults (740). LPA Mixson toured the facility and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. The facility is a single-story cottage facility, located at 14345 Nason Street Moreno Valley, CA. 92555. Physical Plant: The facility phone number is (951) 601-9190 and it is operable. LPA Mixson observed the residents’ living units, and each was furnished with required fixtures as per Title 22. LPA Mixson inspected the facility bathrooms, and the hot water temperature tested within regulations. Facility Manager informed LPA the hot water is tested and logged, along with the monthly disaster drills. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something,” the "Personal Rights," and the LTCO poster. The cleaning supplies and sharp items were locked and inaccessible to the residents in care presently. There were designated storage spaces for the residents’ and staff’s files, and it was locked and inaccessible to residents in care at present. Medications: The medications were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. There were no documented errors observed on the centrally stored medication form, and medications were stored in their original containers during this visit. The facility has two caregivers present and a housekeeping staff arrived shortly after the LPA. Food Service& furniture: The non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents at this time. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. The overall facility is clean; the furniture is in good condition and arranged in a manner which provides space for residents to move safely. The facility cooling system and other appliances were operable at present. Licensee informed LPA there were safety lights for night throughout the facility. Care, Supervision & Administration: There were adequate staff present for the supervision of resident in care at the time of this annual visit. Floor plans, telephone numbers and personal rights were found posted in the facility. The listed Administrator, Emely Rodriguez, possesses a current administrator’s certificate with an expiration date of 06/13/2026. Records Reviewed & Resident/Staff Files: The LPA reviewed staff files and reviewed the facility's staff schedule. The staff files reviewed have criminal clearance, updated training, along with current First Aid certification. Resident files reviewed possessed the required paperwork as per Regulations at the present. Disaster preparedness: LPA Mixson reviewed the facility's emergency & disaster plan as well as the training binder. LPA observed the last fire drill met the Department standards and was logged, as required per Regulations. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found required infection control measures met the Department requirements. An exit interview was conducted, and a copy of this report was reviewed and given to Vicktoria Garcia, Facility Manager.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: Case Management - Other

On January 10, 2025, Licensing Program Analysts (LPAs), Abdoulaye Zerbo and Seo Jeon did an unannounced visit to conduct a case management, and met with the Administrator Emely Rodriguez. LPAs introduced themselves and stated the purpose of the visit. LPAs toured the facility, along with the Administrator Emely Rodriguez and made observations. The facility have three(3) staff per shift attending the residents' needs and conducting rounds every hour or more frequently if needed. The administrator stated that they are doing constant fire check to make sure all residents stay within the premises. There were no imminent health and/or safety concerns observed at the time of visit. LPAs did not observe any obstructions or debris inside or outside of the facility at the time of this visit. LPAs observed the facility is using a generator as a source of power due to the outage. LPAs assessed the available food and observed sufficient food to be available for the residents in care. The food supply meets the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care. The facility is clean, and meets all the requirements for the residents in care. Based on the information obtained during today's visit, there were no immediate health and safety issues of the residents in care. An exit interview was conducted, and a copy of this report was provided to the Administrator, Emely Rodriguez.the state’s words, verbatim · CDSS document, Jan 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Abdoulaye Zerbo, and Ferrer Sabarias conducted an unannounced visit for a required annual inspection. The LPAs were greeted by the facility managers Victoria Garcia and Miesha Wright, notified them of the purpose for the visit and were allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 12 residents bedrooms, and 13 bathrooms. There is no gated pool and there are no firearms on the premises. Infection Control: LPAs 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 a kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with an expiration date of 07/15/2025. LPAs observed the hot water temperature to meet requirements at 107.6°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of June 10th, 2026 and a CPR certification with the expiration date of 06-25-26 Record Review and Resident/Staff Files: LPAs reviewed files for six(6) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Six (6) residents' files were reviewed and contained all required documentation. LPAs observed Staff and resident files, to be stored in a locked cabinet. The first aid kit was stored in a cabinet in the office. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the medication room. LPAs reviewed medications for four residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 11-04-2024, 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 managers Victoria Garcia and Miesha Wright.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Required - 1 Year

On 11/16/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA met with Administrator, Emely Rodriguez and Assistant Manager, Janita Dirden who were informed of the purpose of visit. LPA toured the facility with Janita Dirden. The following was observed, reviewed, and inspected: The physical plant, in general, was in good repair. The facility is operating in the capacity approved by Community Care Licensing (CCL). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. LPA inspected a sample of resident bedrooms and bathrooms. Resident bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. Room temperatures were comfortable for residents in care. LPA inspected a sample of resident bathrooms; LPA observed bathrooms to be clean and sanitary. There is also a good number of personal toiletries available for the residents in care. LPA measured the hot water temperature in the sampled bathrooms, in which all bathroom sinks measured within regulation. Sampled bathrooms were equipped with non-skid surfaces and grab bars. Bedrooms were equipped with a pull cord system to notify staff of any emergencies. LPA toured the kitchen and dining area. The facility was stocked with a 2-day supply of perishable and 7-day supply of non-perishable food items that were labeled appropriately. The facility had a menu posted and available for review. Dishes, glasses, and utensils were in good condition and stored in a healthful manner. LPA inspected the common areas. Smoke detectors were last tested on 7/24/2023 by Costco. LPA observed several carbon monoxide alarms throughout the facility. Continue on LIC-809-C Continued from LIC809 There was a locked and centralized storage area for medications, including refrigerated medications. Medications appeared to be dispensed and documented appropriately. The facility had a designated area for resident files and staff files. All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Random staff and residents' records were reviewed. All required postings were posted near the entryway and throughout the facility. There was adequate seating in the common areas and several activity rooms. LPA observed several activity posters. The facility was also equipped with a complete first aid kit as well as the first aid manual. LPA inspected the outdoor area of the facility. There was shaded area with seating. Overall, the facility was clean, in good repair, and operating in safe conditions for residents in care. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Emely Rodriguez.the state’s words, verbatim · CDSS document, Nov 13, 2023