Irvine Cottage #2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to the facility to conduct an Annual Required inspection. LPA was greeted and granted entry by staff and explained the reason for the visit. The facility is a one story building with an approved fire clearance for six non-ambulatory residents of which six may be on hospice. The facility currently has a census of six residents with three residents on hospice. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two bathrooms. The hot water temperature measured between 114 and 115.8 degrees Fahrenheit and all smoke detectors were operational. The facility’s last fire drill was conducted on March 01, 2026. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review completed medication appear to be being given as prescribed. LPA reviewed two out of two staff training and fingerprint records. LPA conducted a complete review of resident records. LPA confirmed that administrator has a current administrator certificate which expires on July 21, 2026 Based on the observations made during today’s visit no deficiencies cited on this date. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 23, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to the facility today to conduct an Annual Required inspection. LPA was greeted and granted entry by staff and explained the reason for the visit. The facility is a one story building with an approved fire clearance for six non-ambulatory residents of which six may be on hospice. The facility currently has a census of six residents. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two bathrooms. The hot water temperature measured between 109 and 115 degrees Fahrenheit and all smoke detectors were operational. The facility’s last fire drill was conducted on March 01, 2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review completed medication appear to be being given as prescribed. LPA reviewed four out of four staff training and fingerprint records. LPA conducted a complete review of resident records. LPA confirmed that administrator has a current administrator certificate which expires on July 21, 2026 Based on the observations made during today’s visit no deficiencies cited on this date. An exit interview was conducted with Administrator Kimberly Arnett, Compliance Manager Michelle Nesbitt and Executive Administrator Jozef Springer and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 15, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea and Licensing Program Manager (LPM) Sheila Santos conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 9:30, LPA and LPM were greeted and granted entry into the facility by caregiver, Julita Galima and explained the reason for the visit. Upon entry the caregiver measured LPA and LPM temperature following the Infection Control plan protocol of the facility. Facility is licensed for 6 non-ambulatory residents and has 5 residents, of which two are on hospice during today's visit. The Administrator, Kimberly Arnett has an Administrator Certificate expiring on 07/21/2024. Administrators Kimberly Arnett and Michelle Nesbitt, Executive Administrator Jozef Springer, and Licensee Angela Kutnerian arrived shortly after to assist during the visit. LPA Tea, LPM Santos along with the Administrator toured the facility at 9:46 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 5 resident bedrooms, 1 staff bedroom, 2 resident bathrooms, living room, dining room, and kitchen. At 10:00AM LPA observed smoke detectors/carbon monoxide in common areas and bedrooms and operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 114.8 F degrees and 116.2 degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA and LPM observed a locked storage area for cleaning supplies underneath the kitchen sink. LPA and LPM observed secured medications in a cabinet. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating and the exit gate is self latching and operational. LPA observed emergency food and water supply in the garage. LPA reviewed the emergency disaster plan during the visit, last fire drill was conducted March 01, 2024, quarterly. Plan is thorough and complete. Facility provides activities in the form of games, exercise, and art. At 10:50 AM, LPA Tea reviewed five resident files and four staff files. Residents files and staff files contained all required documentation. At 11:30 AM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was read and provided through email to the facility.the state’s words, verbatim · CDSS document, May 8, 2024