Living Water Eldercare

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Ivashia Wright conducted an unannounced 1 year visit. LPA was granted entrance by caregiver Allan Calibo. Administrator Annie Mikenas arrived shortly after. The home is licensed to provide care to six (6) non ambulatory adult residents. A tour of the facility was conducted inside and out of physical plant, the following was observed.The facility is a single story building with four (4) residents bedrooms, one (1) staff room two (2) bathrooms, a living room, a kitchen area, a garage and a shed. There is no gated pool and there are no firearms on the premises. The facility is operating in the capacity and conditions approved by community care licensing. The Facility was observed clean and free of odors. The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Dishes and utensils were in sufficient supply and in good repair. Knives and other sharp objects are stored in a locked cabinet in the kitchen area. Disinfectants and other cleaning solutions were observed in a locked cabinet in the kitchen area. LPA observed fire extinguisher to be in compliance with the department requirements and with an expiration date of 1/13/2027. Resident bedrooms had the required bedding, furniture, and lighting. Smoke and carbon monoxide detectors were observed to be operable. Facility's temperature was comfortable. Hot water measured at 111.5 within the department's requirements. Showers and toilets are operable. Linens and hygiene items are sufficient for residents. Each room is equipped with lamps and appropriate lighting to ensure residents’ comfort and safety. Non-perishable and perishable food is sufficient. Food is being prepared and stored properly. Facility has a variety of food available for residents. Administrator Annie has Administrator certificate displayed which expires 07/1/2027 and CPR certificate which expires 2/17/2027. No immediate health and safety concerns were observed during the visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator Annie Mikenas.the state’s words, verbatim · CDSS document, Feb 23, 2026

Type of visit: Case Management - Other

This Case management inspection is being conducted by Licensing Program Analyst (LPA) Abdoulaye Zerbo on 11-05-25 for the purpose of issuing a technical violation for deficiencies observed during the investigation into Complaint Control No. 18-AS-20251030102544. LPA met with Licensee Jane Mikenas and explained purpose of the visit. During the facility visit, the Licensing Program Analyst (LPA) observed a hole approximately 13 cm in diameter in resident R2’s room. The licensee explained that R2 is a new resident and the damage occurred on October 26, 2025. According to the licensee, R2’s son requested that the damage remain untouched until their visit on November 8, 2025, to allow for a discussion with resident R2. The licensee committed to repairing the damage by November 14, 2025, and to submitting proof of correction. As a result, a technical violation will be issued. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to Licensee Jane Mikenas.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by Caregiver Allen Calibo, notified him of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with four (4) residents bedrooms, one(1) staff room two(2) bathrooms, a living room, a kitchen area, a garage and a shed There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers not to be in compliance with the department requirements with an expiration date of August 22, 2024. A citation will be issued.The water temperature was tested within regulations. Continued 809-C...... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of July 01, 2025 Record Review and Resident/Staff Files: LPAs reviewed files for two(2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five (5) residents' files were reviewed. LPAs observed first aid kit to be locked and inaccessible to the residents in care. The residents and staff files were kept in a locked cabinet in the hallway and inaccessible to unauthorized individuals Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the hallway. LPA reviewed medications for five residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPAs reviewed the facility’s emergency and disaster plan. LPA did not observe any records of the last drill conducted at the facility. A citation will be issued. All facility exits were clear of obstructions. An exit interview was conducted, during which this report was reviewed, and a copy was provided to caregiver Allen Calibo along with the appeal rights.the state’s words, verbatim · CDSS document, Jan 24, 2025

Type of visit: Prelicensing

On 1/31/2024, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an announced pre-licensing inspection at the facility. LPA Nwogene met with Applicant, Annie Jane Mikenas and toured the facility. Application: The application is for a Residential Care Facility for the Elderly. The fire clearance has been granted for six (6) non-ambulatory residents. Buildings and Grounds: The home is composed with living room, kitchen and dining room combination, four (4) clients bedrooms, 2 restrooms, a staff room, laundry room, backyard, and a garage. The interior/exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were tested and operable. There are no pools or other bodies of water located at the home. According to Annie, there are no weapons stored in the home. Rooms, furniture, beds, mattresses are all in good repair. The bedrooms are furnished and privacy is available. The dining and living room areas/furniture are clutter free and in good condition. Bathrooms were observed to have non-slip mats and grab bar available. The hot water was tested and measured at 117 degrees Fahrenheit which is within regulatory limits. Outdoor areas had sufficient room for activities. A washing machine and dryer are available and in working order. Central heating and air conditioning system installed with a central panel located in hallway to control entire house. Storage and Supplies: Medications will be stored in a locked hallway closet, inaccessible to any unauthorized individuals. Secured areas are available for facility files and resident files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored away in the laundry room, inaccessible to clients. Fire extinguisher was available and fully charged. CONTINUE ON LIC809-C CONTINUED FROM LIC809 Activities: Inside and outside, there are areas for residents to use for their leisure. Backyard is in good condition with a covered patio to provide shade over the outside table and chairs. Activity supplies are present inside the home, including television, magazines, and games. Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove are in working order. Sharps will be stored in a locked kitchen cabinet, available only to authorized individuals. Trash cans has tight-fitting lid. Dishwasher will be used to clean and sanitize dishes. All need appliances were present and shown to be in working condition and clean. Fridge and freezer are large enough to accommodate required perishable foods. Forms: The following signs were observed to be posted at the home: Emergency Disaster Plan (LIC 610E), Theft and Loss Policies, Visitors Policy, Personal Rights, rights of resident council, a Facility Sketch (LIC 999), Labor Law Information, and Complaint Information. LPA observed resident bedroom #1 was being used as a staff room and staff room being used as resident bedroom. Annie stated there was a mistake with the bedroom labeling on the facility sketch and a new facility sketch will be submitted. Missing Item; Updated Facility Sketch Drawers for Resident bedroom #4 LPA Nwogene will inform the Centralized Applications Bureau (CAB) that the home is ready for licensure when proof of the missing items has been received. An exit interview was conducted were this report was discussed with and provided to Annie Jane Mikekna.the state’s words, verbatim · CDSS document, Jan 31, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Annie Jane Mikenas (Corporate Board Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On November 03, 2023, 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 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, Nov 3, 2023