Marian House for Seniors

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso, conducted a Required - 1 Yeari Inspection, on 3/10/26 at approximately 9:20am, and met with Licensee/Administrator Sheila Sumabat. LPA observed two (2) caregivers, Rosie and Fely, on duty. There are currently six (6) residents in care. Facility has a dementia plan of operation. There is an approved hospice waiver for four (4) residents. The facility has a required infection control plan. The facility has a required emergency & disaster plan. Per review of records, fire/emergency drills are being conducted quarterly with staff as required. Fire clearance is approved for six (6) non-ambulatory. Facility has smoke alarms, and a carbon monoxide detector, all were working properly during the inspection. Fire extinguishers were serviced and tagged as required. LPA reviewed six (6) resident files. Files were complete, including medication records. All medications were locked, and centrally stored as required by regulation. LPA reviewed five (5) staff files. All staff have criminal record clearance as required. All staff have first aid certification and CPR certification. LPA reviewed staff training; Staff were current in annual training hours per regulation and H&S Code. All staff had current medication training as required. LPA toured the facility with the Administrator, Sheila. Hot water was measured at 116.5 degrees Fahrenheit. All exits were free and clear of any obstructions. Facility had sufficient linens, furnishings, paper products, cleaners/disinfectants, personal protective equipment (PPE) for staff/resident use, and supply of hygiene products for residents in care. Continued on LIC809C.. Facility had sufficient lighting in bathrooms, resident rooms, hallways, and all common areas for residents in care. The home was observed to be at a comfortable temperature during the inspection. The food supply was sufficient, observed a large variety of meats in the freezer, fruits on the kitchen counter and in storage, vegetables, bread/rolls, grains, milk, cheese, eggs, juice, water, and variety of food perishable and non-perishable items. LPA is requesting the following documents be updated and submitted by 4/10/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required-no changes submit copy of review page) If changes submit plan copy Infection Control Plan (ensure to review and update as needed/required- no changes submit copy of review page)- If changes submit plan copy LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Current Liability Insurance Resident Roster Copy of current Administrator Certificate (s) No deficiencies cited today. Exit interview conducted with Administrator/Licensee Sheila Sumabat.the state’s words, verbatim · CDSS document, Mar 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso, conducted a Required - 1 Yeari Inspection, on 2/25/25 at approximately 9:20am, and met with Administrator Sheila Sumabat. LPA observed two (2) caregivers, Rosie and Fely, on duty. There are currently five (5) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. The facility has a required infection control plan. The facility has a required emergency & disaster plan. Per review of records, fire/emergency drills are held quarterly as required: Last emergency drill conducted was a fire drill and winter storm preparedness review, held on 1/6/25 with staff.. Fire clearance is approved for six (6) non-ambulatory. Fire extinguisher is serviced and tagged as required. Facility has smoke alarms, and a carbon monoxide detector, all were working properly during the inspection. Fire extinguishers were serviced and tagged as required. LPA toured the facility with the Administrator. Hot water was checked at 112.6 degrees Fahrenheit. All exits were free and clear of obstruction. All exits had auditory alarms. All resident rooms, hallways, and common areas all had sufficient furnishings, and lighting for residents in care. All bathrooms had grab bars, and the shower bathroom had a mat for resident use. Medications were all locked and inaccessible to residents in care, and to those staff that are not trained to assist residents with medications. All cleaners/disinfectants, soaps/detergents, were all locked up and inaccessible to residents in care. Sufficient food supply for residents in care. Sufficient paper products, hygiene products, linens, and personal protective equipment (PPE) for use as needed. Front yard, the backyard deck and yard space was clean and orderly. All walkways were free and clear. The backyard emergency fire gate opened freely. LPA reviewed five (5) resident files, including medications and medication records. LPA reviewed four (4) staff files. All staff had required criminal record clearance. All staff had first aid and cpr certification as required. All staff had required training. Continued on LIC809C... LPA is requesting the following documents be updated and submitted by 3/25/25. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required-submit copy of review page) If changes submit plan copy Infection Control Plan (ensure to review and update as needed/required- submit copy of review page) If changes to infection plan, submit copy Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate No deficiencies cited today. Exit interview conducted with Administrator/Licensee Sheila Sumabat.the state’s words, verbatim · CDSS document, Feb 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso, conducted a Required 1 -Year Inspection, 2/27/24 at approximately 1:15pm, and met with Lead caregiver Rosie (Rosario) Achacon. LPA observed another caregiver, Fely Delapena, on duty. Caregiver Rosie contacted the Licensee/Administrator Sheila Sumabat to notify them of the LPA's arrival to the facility. Administrator Sheila arrived within 20 minutes of being contacted. There are five (5) residents in care. The facility has a required infection control plan. The facility has a required emergency & disaster plan. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. Fire clearance is approved for six (6) non-ambulatory. Fire extinguisher is serviced and tagged as required, expires 8/17/24. Facility has smoke alarms as required, and a carbon monoxide detector as required. Per review of records, fire/emergency drills are held quarterly as required: Last drill conducted was a fire and evacuation drill, held on 1/2/24. The facility held a fire, and earthquake drill 10/20/23, and three other emergency drills in the year 2023. The LPA toured the facility with caregiver Rosie. Hot water was checked at 113.2 degrees Fahrenheit. Medications were locked up as required. Cleaners/toxins were locked up as required. All exits and walkways were clear, and unobstructed as required. LPA observed there was sufficient lighting in hallways, bathrooms, common areas, and resident rooms. Facility was observed to be at a comfortable temperature. Facility was observed to clean and orderly. Food supply was sufficient. Facility had emergency supplies stored to meet the "72 hours in place" requirement. `Continued on LIC809C... Facility had a sufficient supply of linens, and furnishings for resident use. There is an outside patio area, with table, umbrella, and chairs for resident use. All resident bathrooms had grab bars as required. Resident shower room has grab bars, and shower mat for resident use. The LPA reviewed five (5) resident files. All files were complete. LPA reviewed five (5) staff files. LPA reviewed staff training. All five(5) staff have criminal record clearance as required. All staff are associated as required. All staff had required annual training. All staff had current First Aid and CPR Certification. LPA is requesting the following documents be updated and submitted by 3/27/24: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan- review and submit (provide all information in all boxes as required) Infection Control Plan- review and submit (provide all information as required) Copy of LIC400 Handling of Client Cash Resources (complete the form even if not handling cash) Copy of required Surety Bond (if handling cash) Copy of Current required Liability Insurance Copy of current Administrator Certificate There were no deficiencies cited today.the state’s words, verbatim · CDSS document, Feb 27, 2024