Madison Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Volunteer Dave Cornejo. LPA met with Staff Arlyne Cornejo and the purpose of the inspection was discussed. During the inspection, LPA and Staff Dennis Cornejo conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with six resident bedrooms, one staff bedroom, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested between 112.2–114.0 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated November 6, 2025. Gas stove, microwave, laundry washer and dryer were observed to be operable. Medication cabinet was observed to be locked. LPA reviewed medication and medication administrator records for select residents and did not observe any discrepancies. LPA reviewed three resident files and two staff files. One of three resident files did not include results of an examination for Communicable tuberculosis; a Deficiency was cited on today’s date. LPA interviewed three residents and two staff. Based on the observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jun 15, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced Plan of Correction (POC) inspection for the purpose of following up on deficiency re-cited during POC visit on October 23, 2025. LPA was greeted and granted entry by Staff Dennis Cornejo. LPA met with Staff Arlyne Cornejo and the purpose of the visit was discussed. Deficiency 87465(a)(5)(A) was cited due to there being no authorization from Resident’s 1 (R1’s) physician for one of their prescribed medications. During today’s visit, LPA observed medication has been discontinued per physician’s orders and staff stated medication has since been destroyed. POC has been met and deficiency previously cited will be cleared. Based on today’s observations, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced Plan of Correction (POC) inspection for the purpose of following up on deficiencies cited during required annual inspection. LPA was greeted and granted entry by Staff Arlyne Cornejo and purpose of the visit was discussed. Deficiency 87465(a)(5)(A) was cited due to there being no authorization from Resident’s 1 (R1’s) physician for one of their prescribed medications. During today’s visit, LPA observed there is still no authorization from R1’s physician for one their prescribed medications. Per Staff, medication has been discontinued however was unable to provide a discontinued order from R1’s physician and the medication remains with R1’s centrally stored medication. Deficiency 87465(h)(2) was cited due to medication requiring refrigeration being observed to be accessible to all facility residents in the kitchen fridge. During today’s visit, LPA observed there is a separate mini fridge with a lock in which medication requiring refrigeration is centrally stored. Deficiency 87303(e)(2) was cited due to water temperature testing between 138.3- and 152.6-degrees Fahrenheit. During today’s visit, water temperature tested at 131.0 degrees Fahrenheit. Deficiency 1569.625(b)(2) was cited due to staff files not containing 20 hours of annual training conducted. During today’s visit, LPA conducted file review for two of two staff files and observed files did not contain 20 hours of annual training. Per Staff, they have not completed required annual staff training. Deficiency 87465(h)(5) was cited due to medication for residents being pre-poured into a plastic weekly medication organizer three days in advance. During today’s visit, LPA observed medication for residents is no longer being pre-poured. (Cont. LIC809-C) Deficiency 87506(b)(15) was cited due to three of three resident files reviewed not including a pre-admission appraisal. During today’s visit, LPA conducted file review for three of three resident files and observed a pre-admission appraisal remains to be completed for three of three residents. Deficiency 87463(a) was cited due to two of three resident files reviewed not including an updated pre-admission appraisal. During today’s visit, conducted file review of resident files and observed pre-admission appraisals to be updated. Deficiency 1569.695(c) was cited due to emergency drills not being conducted. During today’s visit, Staff stated emergency drills are still not being conducted. Three of eight POCs have been met and three deficiencies previously cited for will be cleared. Based on today’s observations deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Oct 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5)(A) · Plan of correction due date: Oct 24, 2025

(5)... Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement is not met as evidenced by: Based on observation and staff interview, the licensee did not comply with the section cited above as there is no authorization from R1’s physician for one their prescribed medications and the medication remains with R1’s centrally stored medication.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Staff Cornejo stated an authorization for resident's prescribed medication will be obtained and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(e)(2) · Plan of correction due date: Nov 21, 2025

(2)... Hot water temperature controls shall be maintained to automatically regulate the temperature... to attain a temperature of not less than 105 degree F... and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as water temperature tested at 131.0 degrees Fahrenheit which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Staff Cornejo stated water temperature would be tested and a water temperature log maintained in order to ensure water temperature consists of 105 to 120 degrees Fahrenheit and proof provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(2) · Plan of correction due date: Nov 21, 2025

(2)... training requirements shall... include... 20 hours annually, eight hours of which shall be dementia care training... and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care... This requirement is not met as evidenced by: Based on observation and staff interview, the licensee did not comply with the section cited above as staff files did not include 20 hours of annual training conducted, which poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Staff Cornejo stated 20 hours of annual staff training will be completed and proof provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(b)(15) · Plan of correction due date: Nov 21, 2025

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as resident files reviewed did not include an updated pre-admission appraisal, which poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Staff Cornejo stated resident files will be updated to include updated pre-admission appraisal and a copy provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(c) · Plan of correction due date: Nov 21, 2025

(c) A facility shall conduct a drill at least quarterly for each shift... Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Based on observation and staff interview, the licensee did not comply with the section cited above as emergency drills are currently not being conducted, which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Staff Cornejo stated emergency drills will be conducted and the type of emergency covered in the drill will vary from quarter to quarter and proof will be provided to LPA via email by POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by staff Arlyne Cornejo and explained the purpose of the inspection. During the inspection, LPA and Staff Cornejo conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with six resident bedrooms, one staff bedroom, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 138.3 – 152.6 degrees Fahrenheit; a Deficiency was cited on today’s date. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication cabinet was observed to be locked; however, medication is being pre-poured into a plastic weekly medication organizer for each resident; a Deficiency was cited on this date. Upon review of Resident 1's (R1's) medication records, there was no authorization from their physician for one of their prescribed medications and staff was unable to provide LPA with a copy of authorization; a Deficiency was cited on today's date. Medication requiring refrigeration was also observed to be to accessible to all facility residents in the kitchen fridge; a Deficiency was cited on today's date. (Cont. LIC809-C) LPA reviewed three resident files and observed three of three files did not include a pre-admission appraisal. One of three resident files did not include an updated appraisal dated or signed in the last twelve months; a Deficiency was cited on today’s date. LPA reviewed two staff files and observed two of two staff files did not contain any documentation for staff training conducted in the past year and staff was unable to provide LPA with a copy of staff training conducted; a Deficiency was cited on today’s date. LPA interviewed three residents and two staff. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, May 28, 2025

Type of visit: Required - 1 Year

On 7/26/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA was greeted and granted entry by Caregiver, Dennis Cornejo who was informed of the purpose of the visit. Caregiver, Arlene Cornejo called Administrator, Celso Lapinid and informed them of LPA's visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents, of which one (1) may be bedridden. The facility also has an approved hospice waiver for four (4) and LPA was informed there are currently three (3) residents receiving hospice services at the facility. LPA toured the facility with Caregiver Arlene and observed the facility is made up of a one-story home with six (6) resident bedrooms, three (3) bathrooms, a staff room, kitchen, dining room, living room and attached garage. During the tour, Caregiver Dennis tested three (3) smoke alarms/carbon monoxide detectors and LPA observed them to be operational. LPA also observed charged fire extinguishers mounted throughout the facility. LPA toured the kitchen and observed food was stored in a safe and healthful manner. The facility had more than a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Medications are secured in a locked kitchen cabinet. Indoor and outdoor passageways were free of obstruction. The facility has an outdoor shaded seating area for resident leisure. No bodies of water were observed on the premises. Resident bedrooms had the required furniture and lighting. Bathrooms had grab bars near the toilets and in the showers. LPA also observed the facility has additional clean linens, towels, personal protective equipment, and incontinent supplies stored in a hallway closet. LPA reviewed random staff and resident files. Resident files reviewed had signed admission agreements and updated physician reports. Staff files reviewed had a criminal record clearance and a valid first aid/CPR certification. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted where this report was reviewed and provided to Caregiver Arlene.the state’s words, verbatim · CDSS document, Jul 26, 2024