Irvine Cottage #4

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents and has 6 residents during today's visit. During today’s visit, LPA along with Compliance Manager Michelle Nesbitt toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in bathrooms. The hot water temperature measured between 111.2 and 113.3 degrees Fahrenheit and all smoke detectors were operational. 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 emergency food in locked garage. Facility conducted last fire and earthquake drill 03/01/2026. LPA observed resident's medication securely stored in kitchen cabinet. LPA reviewed medications and all appear to be given as prescribed LPA reviewed three out of three 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 07/21/2026. Therefore based on observations made no deficiencies are being cited per California Code of Regulations Title 22. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 25, 2026

Allegation investigated: Resident sustained a bruise due to staff neglect or physical abuse

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit. The Department received a complaint on 02/11/2026. During the visit LPA Mendivil interviewed staff and residents and obtained copies of staff schedule and resident documents. Regarding the allegation resident sustained a bruise due to staff neglect or physical abuse, the investigation revealed the following: It was alleged that a resident sustained a bruise due to staff neglect or abuse. Per interview with Administrator Kimberly Arnett, it was reported that Resident 1 (R1) sustained a bruise on ring finger on left hand on 01/26/2026. AD stated Staff 1 (S1) reported the injury to Staff 2 (Staff 2) and S2 came to the facility to assess the bruising. Unsubstantiated AD stated she reported the injury to R1's family and a visit from home health was coordinated for an xray on 01/30/2026. AD stated R1's family reported the results of xray as no fractures to the left hand on 02/04/2026. Per review of R1 is diagnosed with anemia and per interviews with staff R1 can refuse assistance with activities of daily living. Per interviews with 4 out of 4 staff stated they have not been neglectful or abusive to R1 or any residents in care. LPA Mendivil was unable to interview residents as they were not oriented to space and time. Therefore based on the preponderance of evidence through interviews and records reviewed the allegation Resident sustained a bruise due to staff neglect or physical abuse is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. No deficiencies cited. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 20, 2026 · control 22-AS-20260211095337

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was greeted and granted entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents and has 6 residents during today's visit. The Administrator has an Administrator Certificate expiring on 07/21/2026. Administrator Kimberly Arnett ,Compliance Manager Michelle Nesbitt were present Jozeff Springer arrived shortly after. LPA Mendivil along with the Compliance Manager toured the facility at 8:30am. 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 9:00am 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 125 degrees and 127 degrees with signage in both bathrooms. 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. LPA observed a locked storage area for cleaning supplies in the garage. 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. At 9:30 AM, LPA 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. Plan is thorough and complete. Facility provides activities in the form of games and exercise. LPA Mendivil reviewed 6 resident files and 3 staff files. Residents files and staff files contained all required documentation. LPA reviewed medication storage and administration. 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 provided to the facility.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Andrea Mendivil and Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPAs were greeted and granted entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents and has 5 residents during today's visit. The Administrator has an Administrator Certificate expiring on 07/21/2024. Administrator Kimberly Arnett ,Compliance Manager Michelle Nesbitt, Tammy Sampedro Executive Administrator arrived shortly after. LPAs Mendivil and Tea along with the Administrator toured the facility at 9:30 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 125 degrees and 127 degrees with signage in both bathrooms. 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. LPA observed a locked storage area for cleaning supplies in the garage. 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. At 10:30 AM, LPA 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. Plan is thorough and complete. Facility provides activities in the form of games and exercise. At 9:00AM, LPA Mendivil reviewed five resident files and 5 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 provided to the facility.the state’s words, verbatim · CDSS document, Mar 22, 2024