La Sierra Cottage

Allegation investigated: Staff do not properly safeguard harmful material

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of investigating the two allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Marie Maniago was notified by phone and arrived later to assist with the visit. During the visit, LPA accompanied by facility staff conducted a tour of the physical plant. There are currently five residents in care. All five bedrooms were visited, along with one shared bathroom, living room, dining room and kitchen which constitute the other areas accessible to residents in care. Three resident interviews and three staff interviews were conducted during the visit. CONTINUED ON FORM LIC9099-C Substantiated CONTINUED FROM FORM LIC9099-A Regarding the allegation that Staff are not properly trained , the following has been concluded: There are three caregivers staffed at the facility currently. Staff member S1 was previously employed at a licensed location operated by the licensee (306006329). Annual training for 2023, 2024 and 2025 was reviewed and verified to include required themes in sufficient hourly quantities for all three years. Staff members S2 and S3 both show a date of hire of October 20, 2025. Their respective initial training was reviewed to include dementia care, postural supports, medication training as well as housekeeping, sanitation, food preparation, infection control as well as emergency safety training. First aid and CPR training was also reviewed to be present for staff members currently being scheduled. As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided to a facility representative. CONTINUED FROM FORM LIC9099 Regarding the allegation that Staff do not properly safeguard harmful material, the following has been concluded: During the tour of the physical plant, LPA and facility staff observed the following: Resident R1 has laundry detergent pods stored on the upper level of their closet. Per staff statement, R1 and their family have requested them to do their own laundry with minimal staff assistance. Per a review of R1's most recent assessment, R1 does not lack hazard awareness or impulse control and their safety would not be at risk if the resident had access to cleaning solutions and/or poisonous substances. Resident R2 has isopropyl alcohol accessible. Identically per a review of R2's most recent assessment, R2 does not lack hazard awareness or impulse control and their safety would not be at risk if the resident had access to cleaning solutions and/or poisonous substances. None of the residents currently admitted appear to have been assessed to require restricted access to toxins. There are however a few bottles of cleaning products accessible under the bathroom's sink which are initially observed to be accessible during the visit. One recently discharged resident (R3) was assessed with dementia and not confirmed to have sufficient cognitive abilities to be able to access such products. One type B deficiency is therefore cited on the attached form LIC9099-D and cleared during the visit. Once pointed out, it was immediately remedied by facility staff with the installation of a safety lock. Additional dangerous items such as sharp utensils are verified to be secure in two kitchen drawers. Kitchen cleaning supplies are also secured. Based on observation and staff interviews, the allegation that Staff do not properly safeguard harmful material is found to be Substantiated, meaning that the preponderance of evidence standard has been met. therefore. See LIC9099-D for cited deficiency per Title 22 Division 6 of the California Code of Regulations. 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 10, 2025 · control 22-AS-20251104153925

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(c) · Plan of correction due date: Nov 10, 2025

Per CCR87309(c), the licensee shall implement reasonable interventions in order to ensure that (...) potentially toxic substances, (...) are stored so as not to pose a hazard to residents. This requirement is not met as evidenced by: Based on observation and interviews conducted, cleaning products were left accessible in the shared bathroom. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Nov 10, 2025

Plan of correction: Licensee installed a safety lock on the bathroom cabinet used for the storage of cleaning products during the present visit. Deficiency cleared during the initial visit.

Type of visit: Prelicensing

On October 10, 2025, Licensing Program Analyst (LPA) Garlli Tat made an announced visit to the facility to conduct a pre-licensing inspection to ensure the water temperature is compliant with Title 22 Regulations. LPA was greeted and granted entry into the facility by applicant Marie Maniago. LPA was accompanied by the applicant and observed the water temperature in the resident bathroom now measures at 114.4 degrees Fahrenheit. All the corrections noted during the initial pre-licensing inspection conducted on October 1 and follow-up inspection on October 3, 2025, have now been corrected. All items reviewed during the visit are in compliance. Facility appears to be ready for licensure. The applicant was notified that the final application approval will be issued by Centralized Applications Bureau (CAB). An exit interview was conducted with applicant Marie Maniago and a copy of this report was reviewed and provided with the applicant.the state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Prelicensing

On October 3, 2025, Licensing Program Analyst (LPA) Garlli Tat made an announced visit to the facility to conduct a 2nd pre-licensing inspection to follow up on corrections identified during the initial pre-licensing inspection, see LIC 809 dated October 1, 2025 for additional details. LPA was greeted and granted entry into the facility by Applicant Marie Maniago. LPA, accompanied by the applicant, conducted a tour of the facility and observed the following: A self-latching gate by the entrance on the right side facing the house. The left side of the yard has been cleared of paint cans and boxes. A stairway safety gate has been mounted in front of the stairs leading up to the office and staff bedroom. The water tank has been drained and the water temperature now measures at 120.7 degrees Fahrenheit. All the corrections noted during the initial pre-licensing inspection conducted on October 1, 2025 have now been corrected. The applicant was notified that the final application approval will be issued by the Centralized Applications Bureau (CAB). An exit interview was conducted with Applicant Marie Maniago and a copy of this report was reviewed and provided.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Garlli Tat and Licensing Program Manager (LPM) Sheila Santos conducted an announced pre-licensing visit to the facility and was greeted and granted entry by applicant Marie Maniago. LPA reviewed the Administrator's Certificate that expires on June 6, 2027. LPA toured the exterior and interior portion of the facility with Marie Maniago. Facility is a two-level structure home. On July 10, 2025, The Orange County Fire Authority granted fire clearance for a capacity of six residents (one of which may be ambulatory, four of which may be non-ambulatory, one may be bedridden, and a request for hospice waiver for six has been submitted for review). There are a total of six bedrooms, four of which are private resident rooms, one shared resident bedroom, and one staff bedroom. There is a garage that is utilized for storage. All bedrooms were provided with brand new furniture's, in good repair, clean linens, adequate storage space, and kept hazard free. The bathrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in residents' bathrooms were measured at 134 degrees Fahrenheit. Applicant will have the water heater tank inspected since the water is still hot even after several attempts of adjustments were made during the visit. LPA will test the water on the 2nd pre-licensing visit schedule. Adequate supply of brand new linens are stored in the hallway. LPA observed the PUB475 "See Something, Say Something" poster posted by the front entrance. Emergency disaster plan is posted in the dining room. Facility met the minimum two days and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen drawers. Facility had back-up emergency food and water supply located in the kitchen cabinet. Continued on LIC 809-C. Wired smoke and carbon monoxide detectors were tested and operational. All auditory exit alarms were tested and observed to be operational. Fire extinguisher was fully charged, mounted, located in the kitchen, and tagged for the date of April 8, 2025. Stove is a four-burner induction stove, and there is single oven, dishwasher, refrigerator and freezer. Washer and dryer are located in the garage. All appliances were operational. Toxins were locked and inaccessible to residents underneath the kitchen sink. LPA observed that First-Aid kit had all the required components. Medication cabinet was observed in the dining room area. Applicant will keep this locked at all times. A body of water was observed in the backyard. A locked fence surrounds the pool area. There are two exit gates in the backyard, one of which is self-latching. Brand new binders were observed and kept in a locked cabinet located in the hallway for resident and staff files. The facility has activities that commensurate with plan of operation. LPA reviewed the Component III with applicant, Marie Maniago. A 2nd Pre-licensing visit will be scheduled on October 7, 2025 for the following to be corrected: Missing self-latching gate entrance on the right side facing the house. Applicant to clear the left side yard to ensure the safety of the residents, LPA observed multiple canned paints and boxes. Applicant will install a lock gate by the entrance of the small stairs going towards the staff room and office. Applicant will have the water heater tank inspected since the water is still hot even after several attempts of adjustments were made during the visit. Water temperature was measured 134F degrees. LPA will test the water on the 2nd Pre-licensing visit. LPA will provide copy of this report to Centralized Applications Bureau for review and final determination of the application. LPA conducted an exit interview with Marie Maniago and a copy of this report was reviewed and provided to the facility.the state’s words, verbatim · CDSS document, Oct 1, 2025