Ivy Cottages I

Type of visit: Required - 1 Year

On July 31, 2026, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit. Upon arrival at the facility, LPA Bentley introduced self and was granted entry into the facility by staff, after stating the purpose of the visit. Administrator (AD) Carmen Rodriguez was present and assisted with the inspection. Carmen Rodriguez has an administrator certificate that expires on May 21, 2028. The facility is licensed to operate for six (6) non-ambulatory residents, with a Hospice waiver for three (3) residents. The building is a single-story home located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, two (2) full bathrooms, living room area, dining area, kitchen, an outdoor covered seating area, and an attached two car garage. The garage is currently under construction, for which the facility has a permit. There are currently six (6) residents on census. During the visit, LPA toured interior and exterior of the physical plant with AD and the following was observed: There were no bodies of water on the premises. All rooms were inspected and the facility to be sanitary and appropriately furnished at the time of visit. Beds and bedding supplies were in good condition, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. A comfortable temperature of 72 degrees F was maintained in the facility. Bathrooms were found to be clean and operational with water temperatures measured between 110.1 degrees F and 113.3 degrees F. The kitchen was observed clean with all appliances in working order. There is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. CONTINUE TO LIC809-C.... LPA toured the backyard and observed a shaded seating area with a table and chairs for residents to sit outside. There is one exit gate leading to the front yard where a tent with items transferred from the garage are being stored. A Technical Violation is being provided. The smoke alarms and carbon monoxide detectors were operable. An emergency safety drill was last conducted on June 5, 2026. First aid kit is maintained and contains all the necessary elements. A working telephone (714)965-0412 remains available and the facility has a device that can be used for video teleconference purposes. Emergency food, water, and supplies were stored in the tent. The facility has one (1) fire extinguisher that was charged, mounted, and serviced on August 12, 2025. Liability Insurance is effective April 30. 2026, and expires on April 30, 2027. LPA conducted an audit of six (6) resident files (R1-R6), five (5) staff files (S1-S5), and medication and medication administration review. A record review revealed Resident #1 (R1) has a restricted and prohibited health condition that was not reported to the Department. Based on observations, interviews, and record review, deficiencies are being cited as per Title 22, Division 6, Chapter 9 of the California Code of Regulations. An exit interview was conducted with Administrator Carmen Rodriguez, and a copy of this report, LIC809-D, LIC811, and appeals rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 31, 2026

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On August 4, 2025, at 3:15pm, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Michelle Franco. Administrator (AD) Carmen Rodriguez later joined the inspection and was present during the inspection. LPA stated the purpose of the visit and requested Resident/Staff rosters and Personnel Record. The facility is licensed to operate for six (6) non-ambulatory residents, of which one (1) may be bedridden, and has a hospice waiver for three (3) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, two living room areas, dining area, kitchen, an outdoor covered seating area, and an attached two car garage. LPA Bentley toured inside and outside of the physical plant with AD Rodriguez. There are no obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each 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 clean and operational. The water temperature measured 109.0 degrees F to 112.6 degrees F. CONTINUE TO LIC809-C.... LPA Bentley observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. During the visit, LPA Bentley observed all mandated inspection control posters were posted. A comfortable temperature of 78 degrees F was maintained in the facility. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-965-0412) remains available, and the facility has a device that can be used for video teleconference purposes. Emergency food, emergency water, and emergency supplies were stored in the garage. The facility has one (1) fire extinguisher that was charged, mounted, and serviced on August 12, 2024. Liability Insurance is effective April 30, 2025, and expires on April 30, 2026. Emergency safety drills were last conducted on July 1, 2025, and conducted quarterly. First aid kit is maintained and contains all the necessary elements. Based on observations, interviews and record reviews, no deficiencies are being cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA will address the following during the continuation annual visit: • Fire clearance for garage • Medication refrigerator in garage • Food storage • Medication and MAR An exit interview was conducted, and a copy of this report was provided to Administrator Carmen Rodriguez at the end of the visit.the state’s words, verbatim · CDSS document, Aug 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 1:15 PM. During today’s visit, LPA met with Carmen Rodriguez, Administrator (AD). The facility is a seven bedroom, single story building with an approved fire clearance of six non-ambulatory and a hospice waiver for three residents. The facility currently has a census of six residents in care. 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 of two resident bathrooms, and testing auditory devices on all exits. All resident rooms had the required furnishings and half-bedrail orders were in resident records. The hot water temperature measured between 105.0 and 113.1 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on August 12, 2024. The facility’s last fire drill was conducted on June 12, 2024. 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 medications are being given as prescribed. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on May 21, 2026. (See LIC 809-C) (See LIC 809) Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Carmen Rodriguez, AD and a copy of the report, LIC 9102-TV and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Aug 15, 2024