Lily Crest Manor

Type of visit: Required - 1 Year

License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit. LPA met with DSP Jeremiah Quijano who contacted administrator and informed administrator of today’s visit. Administrator Anthony Shinn joined visit sometime after. The purpose of today’s visit was explained. The facility is licensed to serve adults 60 years and over, of which two (2) may be bedridden. The licensee is approved for 2 hospice waivers. Residents are serviced by Frank D. Lanterman Regional Center. The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: FACILITY PHYSICAL PLANT The facility is in a residential area and is made up of four (4) resident bedrooms and two (2) staff bedroom, two (2) full bathrooms for resident use and one (1) staff bathroom, living room, dining room, laundry room, front and backyard, and a detached car garage. There were no body of water observed in the property. REVIEW OF FILES Resident record review consisted of Admission Agreements, Identification and Emergency Info, medical assessment, Consent Report, Individual Program Plan, Personal Rights, and Centrally Store Medication. LPA observed that the medical assessment for resident 3 (R3) was missing from resident’s file. R3 is a recent placed resident at the facility. A deficiency is noted on LIC-809D for missing medical assessment. Staff record review consisted of Personnel Report, Health Screening, Criminal Record Statements, Fingerprint Clearance, Training, First Aid and CPR. LPA review facility’s infection control plan, emergency and disaster plan, and liability insurance. (Report continues on page LIC-809C...) Observations during facility tour: Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPA observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for residents. Walls and floors are in good repair. Hallways were clean and free of obstructions. Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable food. Dining room has sufficient seating area. Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean. The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees. Sharps are locked inside the kitchen and inaccessible to residents. Also, Disinfectants and toxics supplies were observed to be in the backyard accessible to residents in care. A deficiency is noted on LIC-809D. Smoke detectors were observed in all bedrooms and carbon monoxide detectors were observed in living room around hallway area. One (1) fire extinguisher was observed and was fully charged with last inspection on 08/27/2025. Last fire drill and earthquake drill were conducted on 05/09/2026. Front yard has a shaded seating area for residents to enjoy. The medications are centrally stored and locked in the staff room. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all four (4) residents. LPA conducted interviews with one staff. Residents were out in the community. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC-809D page. Exit interview was held and copies of reports LIC-809, LIC-809C, LIC 809D, and Appeal Rights were discussed and provided to Administrator Anthony Shinn.the state’s words, verbatim · CDSS document, Aug 20, 2026

Type of visit: Required - 1 Year

License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit. LPA met with Administrator Anthony Shinn. The purpose of today’s visit was explained. The facility is licensed to serve adults 60 years and over, of which two (2) may be bedridden. The licensee is approved for 2 hospice waivers. Residents are serviced by Frank D. Lanterman Regional Center. The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: FACILITY PHYSICAL PLANT The facility is in a residential area and is made up of four (4) resident bedrooms and one (2) staff bedroom, two (2) full bathrooms for resident use and one (1) staff bathroom, living room, dining room, laundry room, front and backyard, and a detached car garage. There were no body of water observed in the property. REVIEW OF FILES Resident record review consisted of Admission Agreements, Identification and Emergency Info, Physicians Report, Consent Report, Individual Program Plan, Personal Rights, and Centrally Store Medication. Staff record review consisted of Personnel Report, Health Screening, Criminal Record Statements, Fingerprint Clearance, Training, First Aid and CPR. Report continues on LIC 809C... Observations during facility tour: Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPA observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for residents. Wall and floors are in good repair. Hallways were clean and free of obstructions. Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable food. Dining room has sufficient seating area. Weekly food menu is posted at facility. Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean. The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees. Sharps are locked inside a kitchen drawer and inaccessible to residents. Also, disinfectants and cleaning supplies are locked and secured inaccessible to residents. Smoke detectors were observed in all bedrooms and carbon monoxide detectors was observed in living room around kitchen area. One (1) fire extinguisher was observed and was fully charged with the last inspection on 8/30/24. Last fire drill and disaster drill was conducted on 5/3/25. Earthquake drill was done on 5/3/25. Front and back yards are free of hazards. Back yard has a shaded seating area for residents to enjoy. The medications are centrally stored and locked in the staff room. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all four (4) residents. LPA conducted interviews with one staff. Two resident interviews were conducted while other residents were out in the community. The facility provides various activities for residents to participate in day programs, community outings, watch TV, music, and going to the park. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit interview held and a copy of the report along was provided to the administrator.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores and Michael Moriel conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Artemio de la Pena and explained the reason for the visit. The facility is licensed to serve 4 non-ambulatory residents over the age of 60, of which 2 may be bedridden in room 3 and 4. Facility has a hospice waiver for two. The facility is a single-story home in a residential neighborhood and consist of a living room, dining area, kitchen, laundry area, 4 resident bedrooms, 2 resident bathroom, 2 Staff Rooms, 1 Staff bathroom, detached garage, front yard, and back patio. LPA conducted a tour of the facility with Artemio de la Pena and observed the following: Facility is in good repair indoor and outdoor. Living room has a covered fireplace. Dining room/living room have sufficient seating area. Kitchen was observed clean, sharps and cleaning solutions were observed locked. Sufficient food was observed for at least 2 days of perishables and 7 days of non-perishables. Each client room was observed with sufficient lighting, the required furniture and bedding supplies. Room #4 was observed with a hole in the front of the door of the size of a tennis ball. Bathrooms were observed clean and in good repair. Water temperature was tested between 101.1 and 102.1 degrees F., which is not within the required 105-120 degrees F. Facility has linens and grooming supplies for residents. Smoke/Carbon monoxide detectors were tested and are in working condition. Back patio was observed and few of the floor planks are chipping down, fence is being held by a wood plank per staff the tree is pushing the fence in, exit passage way to the garage was observed with plants overgrown. No large bodies of water were observed. LPA reviewed medication and files for 4 residents and 4 staff files. Staff were missing 20 hours of training. Infection control plan was last reviewed on 6/30/22. Emergency Disaster plan was last reviewed on 7/8/22. Las fire drill was conducted on 5/28/24. Administrator certificate was observed for Anthony Shinn #6005240740 exp. date: 9/21/25. Deficiencies were noted on LIC 809D per Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 2, 2024

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.