Mariposa Manor

Type of visit: Required - 1 Year

On 08/21/2026 Licensing Program Analyst (LPA) Jacqueline Shaw-Ross arrived to conduct an unannounced annual visit. LPA was greeted by Julia Martinez, Caregiver, and was granted entry. The Administrator, Garrett Welker arrived shortly. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations.The facility has an approved hospice waiver for (6), with a total of (0) residents that are currently receiving hospice services. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies. Physical Plant and Environmental Safety: There are a total of 6 resident bedrooms, and 4 bathrooms, one staff bedroom and bathroom, a kitchen, living room, office area, backyard area with furniture for residents and staff. All rooms, living room, office area, kitchen and dining room are all clean and clear of obstruction. The resident bedrooms were clean and clear from obstruction. The resident’s rooms were complete with and clean linens and bedding, a television, dresser, and closet space. The bathroom water temperature read at 126.2 degrees with appropriate signage indicating the water exceeds 120 degrees to proceed with caution. There are no bodies of water on the premises. Operational Requirements: The facility was staffed with 2 caregivers. The facility meets the operational requirements for an RCE and has a current fire clearance for the facility, smoke and carbon monoxide detectors and fire extinguisher. (Continued on LIC809-C) Personnel Records-Training: All staff have fingerprint clearances, current CPR/First Aid certification, Health screen and TB test completed. All staff complete monthly in-service training and fire drills and disaster training. Client Records-Incident Reports: The resident records are complete with pre-assessments, admissions agreement, physician reports, identification and emergency information, house rules, medication log, daily logs of the resident’s health condition, and additional medical assessments. Client Rights-Information: The resident’s right documentation is present. The resident records also contain needs assessment information for each resident. Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available to residents. Health- Related Services: The caregivers at the facility are dispensing medications within the guidelines of the physician’s order and the regulations. The facility is documenting the date and time of the dispensing of medication for each resident. Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The last fire drill was completed 08/14/2026. The facility has emergency supply of food and water. Based on today's visit, no deficiencies were observed at this time. An exit interview was conducted with Administrator Garrett Welker and a copy of this report was printed Signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Aug 21, 2026

Type of visit: Required - 1 Year

On 08/20/24 at 9:20 am Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility for the purpose of conducting a 1 year required visit. LPA was greeted and granted entry by caregiver Dalia Calderon-Cruz where LPA explained the purpose of the visit. LPA met with Caregiver Garrett Welker who arrived at 10:27am. The facility has an approved hospice waiver for (4), with a total of (4) residents that are currently receiving hospice services. The facility has an approved infection control plan on file as of 05/25/21. Below are the observations made during today's visit: Physical Plant: LPA toured the interior and exterior areas of the facility and observed that there a sufficient bedrooms and bathrooms for both staff and residents. The facility was observed to have the required furniture and linen to be present and in good condition in resident bedrooms. There are no pools or bodies of water on the premises. LPA observed for the required postings (facility sketch, resident rights, CCL complaint poster, LTCO poster) to be in walkway upon entry. Staff Records: LPA observed that there are sufficient staff present to meet the needs of residents. LPA George additionally confirmed that there is an Administrator present, the administrator certificate expires on 01/27/25. LPA George confirmed staff have criminal record clearance and were associated to the facility and have training to perform their required duties, which includes valid First Aid Certification. The facility has a Resident # 5 (R5) that is considered independent, upon review of the facility personnel roster, LPA observed for R5 to not be associated to the facility, the facility does not have Guardian access but will take the necessary steps to have R5 associated, by 5pm on Friday 08/23/24. LPA verified that R5 has obtained the proper criminal record clearance. Per staff R5 was on the roster and somehow fell off. Resident Records: A review of resident files was conducted and were observed to have the required information present in their files, including Physician's Report, Admissions Agreement, and current Needs & Services Plan or assessments. Food Services: The kitchen and dining area to be maintained in a clean and healthful manner. LPA George observed the facility to have the required amount of 7 day supply non-perishable and a two supply perishable food items. Medication: Resident medication was observed to be locked inside a medication cart, However while LPA toured the kitchen LPA observed for there to be a bubble pack of medication belonging to a resident that was no longer at the facility to be sitting on top of the refrigerator. The medications were destroyed during today's visit. LPA observed for there to be (1) resident walking around the facility, that could have accessed the medication. Technical violation (TV) issued. Emergency Disaster Preparedness: The facility has an Emergency Disaster Plan on file and conducts regular disaster drills on a quarterly basis. The last drill was conducted on 07/25/24. The smoke and carbon monoxide detectors were tested and were found to be operable. The facility has fully charged fire extinguisher. There are no known guns or ammunition on the premises. The hot water was tested and was found to be within regulatory limits. Prior to conducting today's inspection LPA completed a file review on 08/01/24, and found for the facility's annual fees to not have been paid, as they were due on 08/08/24. During today's visit LPA followed up and was informed that the payment was mailed off on or around 08/01/24. An exit interview was conducted and a copy of this report, LIC811-confidential names list and TV were provided to Caregiver Garrett Welker.the state’s words, verbatim · CDSS document, Aug 20, 2024