Lilac Chateau 1

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conclude the required annual licensing inspection that commenced on October 16, 2025. LPA was met by Licensee Withers, identified herself, was granted entry into the facility, and stated the purpose of today’s visit. The facility is licensed to serve 6 residents, age 60 and over, of which all 6 can be non-ambulatory, and two bedridden, and approval for two residents receiving hospice services. During today's visit there were 6 residents and 4 staff present. A review of facility, staff, and resident records were observed to be complete and up to date. The facility’s Limited Liability Company (LLC), liability insurance, and the Licensee and their designee Administrative Certification were all current and active. LPA Correia, accompanied by Licensee Withers, also conducted a tour of the interior and exterior of the facility. At the time of the tour the facility’s ambient temperature was 77 degrees Fahrenheit. Hot water taps used by residents in care measured from 114.3 to 119.5 degrees Fahrenheit. Disinfectants, cleaning solutions, and poisons were inaccessible to residents. All residents’ rooms were equipped with the required furnishings. Resident bathrooms were observed to be sanitary and equipped with the required supplies, including grab bars and non-slip mats in the showers. LPA observed smoke alarms, and carbon monoxide detectors throughout the facility that were in operable condition. [Continued on LIC 809C] [Continuation of LIC 809] LPA also observed required postings, first aid kit and manual, and landline. The fire extinguishers were present and current on inspections. The facility’s outdoor area was free from obstructions and had a shaded area and sufficient space for activities and visits. Per Licensee Withers there are no weapons and/or ammunition housed in the facility, nor does the facility have any bodies of water on the premises. The facility is stocked with a 2-day supply of perishable and 7-day supply of nonperishable food items. The food was observed properly stored. Medications were stored in a locked cabinet. The facility's last disaster drill was conducted in September of 2025. LPA observed a sufficient supply of PPE. Based on today's visit, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with Licensee Withers and will be provided with a copy of this report and licensee/appeal rights (LIC 9058 01/16), and their signature on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself to Licensee Withers and was granted entry into the facility. The facility is licensed to serve 6 residents, age 60 and over, six of whom can be non-ambulatory, two bedridden, and approval for two residents receiving hospice services. LPA began a general overall inspection during today's visit however do to time constraints will return at a later complete the inspection. No deficiencies were cited during today's visit. This report was discussed with Licensee Withers. A copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, Oct 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct the required annual licensing inspection. LPA was met by Licensee Withers, identified herself, was granted entry into the facility, and stated the purpose of today’s visit, to ensure that the facility is in compliance with the California Code of Regulations, Title 22, Division 6. The facility is licensed to serve 6 residents, age 60 and over, six of whom can be non-ambulatory, and two bedridden, and approval for two residents receiving hospice services. During today's visit there was 6 residents and 5 staff present. LPA conducted a general overall inspection. The facility temperature was 74 degrees Fahrenheit at the time of the visit. The resident bathroom's hot water temperature measured 114.3 degrees Fahrenheit. Disinfectants, cleaning solutions, and poisons were inaccessible to residents. All resident rooms were equipped with the required furnishings. Resident bathrooms were observed to be sanitary and equipped with the required supplies, including grab bars and nonskid flooring in the showers. LPA observed smoke alarms, and carbon monoxide detectors throughout the facility that were in operable condition. Fire extinguishers were present and current on inspections. The facility’s outdoor area was free from obstructions and had a shaded area and sufficient space for activities and visitations. Per Licensee Withers there are no weapons and/or ammunition housed in the facility, nor does the facility have any bodies of water on the premises. The facility is stocked with a 2 day supply of perishable and 7 day supply of nonperishable food items. The food was observed properly stored. Medications were stored in a locked cabinet. The facility's last disaster drill was conducted on 8/13/2024. The facility’s liability insurance is current until 10/1/2025. LPA observed a sufficient amount of PPE supplies and disinfectants that were inaccessible to residents. Staff records reviewed, included criminal clearance and staff responsible for direct care and supervision have required training and current First Aid and CPR certification. Licensee Withers Administrator Certificate is current. All resident records were present and up to date. Based on today's visit, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with Licensee Withers and will be provided with a copy of this report and licensee/appeal rights (LIC 9058 01/16), and their signature on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Nov 19, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct the required annual licensing inspection. LPA was met by Licensee Withers, identified herself, was granted entry into the facility, and stated the purpose of today’s visit, to ensure that the facility is in compliance with the California Code of Regulations, Title 22, Division 6. There were 6 residents and 5 staff present during today's visit. LPA Correia conducted a general overall inspection. The facility is licensed to serve 6 residents, age 60 and over, six (6) of whom can be non-ambulatory, and two (2) bedridden. The facility temperature was 74 degrees Fahrenheit at the time of the visit. The resident bathroom's hot water temperature measured 109.5 degrees Fahrenheit. Disinfectants, cleaning solutions, and poisons were inaccessible to residents. All resident rooms were equipped with the required furnishings. Resident bathrooms were observed to be sanitary and equipped with the required supplies. Showers had grab bars and nonskid flooring. Lighting was maintained in hallways and passages to client bathrooms. Facility staff provided each resident with clean linen in good repair, and sufficient hygiene products for personal use. LPA Correia observed smoke alarms, and carbon monoxide detectors throughout the facility that were in operable condition. Per Licensee Withers there are no weapons and/or ammunition housed in the facility, nor does the facility have any bodies of water on the premises. The facility is stocked with a 2 day supply of perishable and 7 day supply of nonperishable food items. The food was observed properly stored. Medications are stored in a locked cabinet and administered according to the label instructions. The facility's last disaster drill was conducted on November 9, 2023. Per staff records reviewed, individuals subject to a criminal record review obtained clearance and/or an exemption; staff responsible for direct care and supervision have current First Aid and CPR training. Licensee Withers Administrator Certificate is current until April 10, 2024. Based on today's visit, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with Licensee Withers and will be provided with a copy of this report and licensee/appeal rights (LIC 9058 01/16), and their signature on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Nov 29, 2023