Ivy Cottages III

Type of visit: Required - 1 Year

On June 11, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purposes of conducting a required 1-Year annual visit using the CARE Inspection Tool. LPA Bentley was greeted and granted entry into the facility by staff, after stating the reason for the visit. Administrator (Admin) Carmen Rodriguez arrived shortly to assist with the visit. The facility is licensed to operate age 60 and over for (6) non-ambulatory residents, with a Hospice waiver for three (3). The building is a single story structure located in a residential neighborhood, which consists of the following: six (6) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining room area, kitchen, an outdoor covered seating areas, and an attached three car garage. There is an office with four walls in the garage and an ADU in the backyard, separate from the main house. LPA Bentley toured the inside and outside of the physical plant with Admin. There were no bodies of water or obstructions on the premises. All rooms were inspected and the facility was observed to be appropriately furnished at the time of visit. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Additional linens, comforters, and bath towels were adequately stocked and available. Bathrooms were found to be clean and operational with water temperatures measured between 111.5 degrees F to 114.6 degrees F. The kitchen was observed clean, all appliances were operational, and there is a two-day supply of perishable and seven-day supply of non-perishable food available. Toxins, disinfectants, sharps, and medications were secured and inaccessible to residents in care. The fireplace was covered with a screen and secure. The garage and backyard were observed free of clutter and debris and the facility has one exit gate that was operational during the visit. CONTINUE ON LIC809-C PAGE..... The smoke alarms and carbon monoxide detectors were operable. An emergency safety drill was last conducted on June 5, 2026 and are conducted quarterly. 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, 2025. First aid kit is maintained and contains all the necessary elements. A working telephone (714-775-1128) remains available and the facility has a device that can be used for video teleconference purposes. LPA Bentley conducted an audit of six (6) resident files (R1-R6), five (5) staff files (S1-S5), and medication and medication administration records review were all found in order and complete. Interviews were conducted with staff and residents. Liability Insurance is effective April 30, 2026 and expires on April 30, 2027. Based on today’s observations, no deficiencies were cited during the visit, per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrator Carmen Rodriguez, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jun 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by caregiver staff after explaining the purpose for the visit. Administrator (AD) Carmen Rodriguez was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Carmen Rodriguez has a valid Administrator certificate which expires on May 21, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, with a hospice waiver for three. The facility is a single story home with six private resident bedrooms, three resident bathrooms, two of which are shared, one staff room, a living room, a family room, a kitchen, a dining room, a laundry room, an attached three car garage, and a shed located in the backyard. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed six residents in care, two of which are on hospice, and three caregiver staff present. LPA observed residents eating breakfast in the dining room and relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the family room. LPA inspected the six resident bedrooms and they were observed to be free of hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident linens and blankets to be clean. LPA observed additional linens stored in a cabinet in the resident hallway. LPA observed that the staff room is kept locked and inaccessible to residents in care. LPA inspected the three resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 109 and 109.7 degrees Fahrenheit. LPA observed the kitchen has a two day perishable and seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. CONTINUED ON LIC809-C LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. A fire extinguisher is located in the kitchen and it was observed to be charged and serviced as of August 13, 2024. LPA tested the individual smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 15, 2025. The centrally stored medication is stored in a locked closet by the dining room. LPA observed a First Aid Kit to be stored in the locked closet. LPA inspected the First Aid Kit and observed it to have all the required components. The door leading to the laundry room is kept locked and inaccessible to residents in care. LPA observed chemicals and toxins to be stored in a cabinet in the locked laundry room. The door leading to the attached three car garage is kept locked and inaccessible to residents in care. LPA observed the two car garage is used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA accompanied by the AD toured the exterior portion of the facility. LPA observed the exterior portion to be free of obstructions and hazards. LPA observed an shaded outdoor seating area with furniture for resident use. LPA inspected the shed/office located in the backyard. LPA observed the shed to be locked and inaccessible to residents in care. LPA observed the shed to be used for storage. The perimeter gate on the southside of the facility is self-latching and can be opened in an evacuation. There are no bodies of water located on the premises. LPA reviewed all six resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed the six residents' medication and medication records. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Carmen Rodriguez and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2025

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Carmen Rodriguez and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 9:30AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: this is a one-story home. Facility is a 7-bedroom, 3-bathroom, one-story house with attached garage that is being used for storage. LPA observed 3 staff and 6 residents present at the facility. Resident Bedrooms: the 6 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 1 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 108.5 degrees F in the private client bathroom and 109 in the common client bathroom. LPA inspected all rooms in the facility. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested, including the wired smoke detectors/carbon monoxide detectors. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the medication cabinet. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. LPA discussed licensing fees with AD. At about 10:30AM, LPA reviewed 4 resident files and 3 staff files, interviewed 4 residents and 2 staff, inspected medications for 4 residents, and inspected resident money and ledger for 1 resident. CONTINUED. During the inspection, LPA and AD observed the following. Based on observation and admission, staff have been living in the ADU in the backyard which is not fire cleared as a bedroom and was previously used as an office. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Nov 2, 2023

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.