Luna's Home

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by designee. Designee informed Administrator of LPA visit. Administrator Certificate 7010783740 expires 11/17/27. All fees are current as of this time. Facility currently has four (4) residents in care none of which are currently on hospice. At approximately 10:00am LPA and designee toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled with opened dates present. Kitchen cabinet under sink contains disinfectants and cleaning supplies. Cabinet has magnetic locking mechanism. All other cleaning products and laundry soaps are located in the garage and inaccessible to residents in care. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 110.4 degrees F in the back bath and 111.2 in the front bathroom, both of which are within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 4/23/26. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 2/21/26. Facility has two (2) backup generators for use during a power outage. At approximately 10:30am LPA conducted a review of four (4) staff records. LPA discussed with designee that training requirements include the subjects of postural supports and restricted conditions. Additionally, all Continued on 809C... Continued from 809... staff administering medication must have at least 10 hours of medication training and also must pass a test demonstrating their understanding of the medication training received, test can be kept in staff file. At approximately 11:00am LPA conducted a review of four (4) out of four (4) resident records. No deficiencies cited. At approximately 12:00pm LPA and designee conducted a review of P&I. All receipts present. Ledger in balance with cash on hand. No deficiencies cited. At approximately 12:30pm LPA and designee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA discussed with designee requirement for all doctors' orders to be signed. All medications on current doctors' orders must be documented on Centrally Stored Medication log (CSML). If a medication has been discontinued there must be a discontinuation order on file. LPA discussed with designee PRN MAR requirements and to document a result that is specific. No deficiencies cited. LPA and designee discussed Emergency Disaster Plan. No updates as of recent. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Liability Insurance Surety Bond No deficiencies cited during this inspection. Exit interview conducted with designee and a copy of this report was given.the state’s words, verbatim · CDSS document, Apr 28, 2026

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 2:00PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required visit and met with Lead Staff Member, Shella Pastor. Administrator, Libia Cruz Leon, arrived during visit at approximately 2:15PM. Facility is a Residential Home for the Elderly that provides care and assistance for Older Adults with Disabilities. Facility has an approved fire clearance and capacity for 4 Non-Ambulatory Residents. Facility has a hospice waiver for 1 individual. Upon arrival, LPA was informed that there were 4 residents in care, with 1 resident out of the community attending Day Program. LPA was also informed that there were 3 staff members on site. At approximately 2:10PM, LPA reviewed the Facility's Staff Roster and found that all staff on site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Lead Staff Member and Administrator. LPA observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a one story building with 4 resident bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for resident use. Toxins were observed to be stored inaccessible to residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected May 2025. Per Administrator and Lead Staff Member, Fire Department is coming this week to renew the fire extinguishers. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted February 2026. Facility's emergency and disaster plan was last reviewed and updated 02/26/2026. LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 23, 2026

Type of visit: Required - 1 Year

03/05/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 4 residents in care. Facility approved/cleared for 4 non-ambulatory and hospice waiver for 1. Upon arrival no staff or residents were present. LPA made a phone call and Lead staff, Shella Pastor arrived shortly after. Administrator Libia Cruz-Leon arrived at approximately 12:00 PM to assist with inspection. At approximately 11:45 AM, LPA and lead staff toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. All rooms were furnished per regulation. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 109.4 and 110.5 degrees F which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected 05/2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose threat if available to residents were located in the garage and under the kitchen sink and found to be secured. Personal Protective Equipment is stored in the garage. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. Cash resources were documented. LPA conducted a review of 4 resident records. All records had the required documentation. LPA conducted review of 4 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. Facility conducts quarterly fire and disaster drills with the last one being conducted 01/13/2025. continued on LIC809C No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 04/06/2025: LIC500- Personnel Report LIC400- Affidavit Regarding Client/Resident Cash Resources Updated Liability Insurance Exit interview conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 9:15AM to conduct an Annual Required inspection and was greeted by staff. LPA and staff discussed the purpose of the visit. Back up Administrator, Shella Pastor arrived shortly after. LPA and Administrator initiated a tour of the facility around 09:45 AM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in sinks accessible to clients measured at 112 and 113 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinets containing cleaning supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods which were of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water is stored in hallway closet. Personal Protective Equipment is stored in the garage. Fire extinguishers were last serviced May 17, 2023. Facility has combination smoke and carbon monoxide detectors located throughout the facility that were tested and operational during inspection. Facility is equipped with fire doors on all doors. Most recent fire/disaster drill was conducted 01/14/2024. Client cash resources were reviewed. Facility was over the limit listed on their LIC400 (Affidavit Regarding Client Cash Resources). LPA and Administrator discussed that they must update their LIC400 and their Surety Bond in order to handle a larger sum of cash. Continued on LIC809C Continued from LIC809 Five staff files and three resident files were reviewed. Staff have required First Aid and CPR certificates. Medications and medication records were reviewed. Administrator Certificate for Administrator, Shella Pastor (6060239740) is up to date and expires 07/07/2025. No deficiencies cited during inspection. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on forms confirms receipt of documents. LPA is requesting the following documents to be submitted to Community Care Licensing by 05/03/2024: LIC 500 Personnel Report LIC 9020 Resident Roster LIC 308 Designation of facility responsibility Updated LIC 400 Affidavit Regarding Client Cash Resources Updated Surety Bondthe state’s words, verbatim · CDSS document, Apr 3, 2024