Life Care Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff and LPA explained the nature of the visit. Kayceejoy Viray, Administrator met with LPA. There are four residents at the facility and there is one resident receiving hospice services currently. LPA began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in storage in the garage, in a freezer. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. Medication cross checked for accuracy of date and dosage. LPA inspected the bathroom and LPA measured the hot water temperature which measured 116.7 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink and locked in the storage closet located in the hallway. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Continued LIC809-C Storage space is provided for residents in their bedroom. Carbon monoxide and smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there is several shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher with service date of October 10, 2025, mounted in the kitchen wall. LPA reviewed and verified fire drill logs; LPA verified the last drill was conducted January 15, 2026. Drill is conducted quarterly. Facility has a second floor which is inaccessible to residents in care, door that leads to the second floor is in the entry of the garage door. There are no residents residing on the second floor of the facility. LPA verified resident in care do not have access to the second floor. LPA began review of records. LPA reviewed two resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed two employee records. All employees present have a criminal record clearance and are associated with the facility. LPA observed records reviewed have a current First Aid certificate. LPA as a reminder provided annual fee dues information. Based on the observations 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, Feb 11, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at facility was greeted and granted entry. LPA met with Stevelyn Reroma, applicant and explained the visit. An initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden resident was submitted to CCL on 10/08/24. Structure: The facility is a two story house with an attached garage with 5 resident bedrooms, 1 full bathroom, 3 half restrooms, a living room, a dining room, kitchen on the first floor. The second floor of the facility will be occupied by live in staff with one bedroom and 1 full bathroom. Access to staircase is the door leading to the garage which can be locked for inaccessibility to resident, no resident will reside on the second floor. The resident’s bedrooms on the first floor are spacious and will easily accommodate the resident’s furnishings. The back yard has seating areas for resident and an exit walkway on each side of the house. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with 1 shared room accommodating two residents. Bedroom #1 approved for bedridden residents, Bedroom #2, 3, 4 approved for 1 non-ambulatory resident each. Bedroom #5 approved for 2 non-ambulatory residents. Bedrooms Staff: Second floor is designated for live in caregivers. Bathrooms: Facility has 1 full bathroom on the first floor and 3 half restrooms in bedroom #2, 3, & 5. All bathrooms have a working toilet, wash basin, walk in shower. Second floor has 2 full bathroom 1 bedroom, kitchen and a living room. Continued LIC809-C Linens & Hygiene Supplies: Adequate supply of linen in storage. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables will be stored in the kitchen. Additional food storage in a freezer located in the garage. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested, and found operational. 1 fire extinguishers mounted in kitchen, charged, and dated August 26, 2024. Appliances: Electric four burner stove, single oven, refrigerators, freezer (garage), microwave, washer, and dryer are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents are stored and locked underneath kitchen sink and in the storage closet located between dining room/living room. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 116.2 Fahrenheit degrees in facility bathrooms. Medications, First-Aid Kit & Book: Medication will be stored in a locked cabinet located in the kitchen. First Aid kit and book are stored in storage cabinet adjacent medication cabinet. Resident & Staff Files: Records will be kept locked in storage cabinet located in the kitchen. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the resident's use, commensurate with the plan of operation. Fire clearance: Was approved on November 12, 2024. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Feb 19, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Name - Stevelyn Reroma CEO/Administrator Interview Method: Telephone interview On January 17, 2025, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Jan 17, 2025