Maryam RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection. LPA Rodgers was granted entry into the facility by House Manager Maria Lerma, after identifying herself and stating the purpose of the inspection.. According to the facility’s license, the facility serves six ambulatory elderly residents: ages 60 and above. LPA was accompanied by House Manager Maria Lerma, during a tour of the facility, which was conducted inside and out and included a sample of resident bedrooms, common area, dining area. Exterior and interior passageways were free from obstructions. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Resident’s room temperatures were within a comfortable range. Hot water temperature at taps accessible to residents were all compliant. Each resident had clean and sufficient bed linens, towels, and washcloths. All residents’ rooms were equipped with required furnishings and appropriate lighting to ensure the comfort and safety of residents. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Non-skid mats are present in the showers. Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Medications are locked in a locked closet, not accessible to residents. Medications were labeled and kept in compliance with label instructions. LPA interviewed staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained all required documents. No deficiencies were observed or cited at the time of visit An exit interview was conducted and a copy of this report and Licensee/Appeal Rights - LIC 9058 (rev. 03/22) was provided to the , Maria Lerma Administrator whose signature on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 7, 2026

Allegation investigated: Staff do not treat resident's with dignity. Staff do not treat resident's with respect. Licensee is not providing supervision of resident while in care.

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Leeda Dost, Administrator. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, Outside Sources, and a review of relevant records. On 9/9/24, Community Care Licensing (CCL) received a complaint alleging the facility staff do not treat resident's with dignity. LPA interviewed 3 staff members, including caregivers and administrative personnel. All staff consistently stated they have not witnessed or engaged in inappropriate communication with residents. Staff reported they receive ongoing training on resident rights, dignity, and respectful communication as required by Title 22. Staff demonstrated knowledge of facility policies regarding supervision and personal rights. Unsubstantiated LPA interviewed residents and they reported they feel respected and treated with dignity by staff. None of the residents interviewed reported hearing staff speak inappropriately or disrespectfully. Residents stated staff respond promptly to their needs and provide supervision when assistance is required. LPA contacted an outside source 1 (OS1). OS1 did not report any concerns regarding staff communication or supervision. They stated the facility maintains regular communication and provides updates on resident care. During the visit, LPA observed staff interacting with residents in a calm and professional manner. No inappropriate language or disrespectful behavior was observed. Residents appeared comfortable and engaged in activities. LPA reviewed staff training records, resident care plans, and supervision logs. Documentation confirmed staff completed training on personal rights and supervision requirements. Staff schedules indicated adequate coverage to meet residents’ needs. On 9/9/24, Community Care Licensing (CCL) received a complaint alleging the facility staff do not treat resident's with respect. LPA interviewed staff members regarding their interactions with residents. All staff stated they are trained to uphold residents’ personal rights and treat residents with dignity and respect. Staff described examples of how they provide choices in daily activities, maintain privacy during personal care, and communicate respectfully. No staff admitted or reported observing any disrespectful behavior toward residents. LPA interviewed residents. Residents consistently reported feeling respected and valued by staff. Residents stated staff address them by their preferred names, listen to their concerns, and provide assistance in a courteous manner. None of the residents reported any incidents of humiliation, neglect, or disrespect. LPA contacted OS1 and they expressed satisfaction with the care provided and did not report any concerns regarding staff treatment of residents. They confirmed that residents appear comfortable and well cared for during visits. During the visit, LPA observed staff interacting with residents in a professional and respectful manner. Staff were seen assisting residents with activities of daily living while maintaining privacy and dignity. No inappropriate or disrespectful behavior was observed. LPA reviewed staff training records and confirmed completion of courses related to resident rights, dignity, and respectful communication as required by Title 22 and Health & Safety Code. Facility policies reinforce these principles. On 9/9/24, Community Care Licensing (CCL) received a complaint alleging the Licensee is not providing supervision of residents while in care. LPA interviewed staff members regarding supervision practices. Staff stated they are assigned to specific areas of the facility to ensure residents are monitored and assisted as needed. Staff reported that supervision is maintained through scheduled rounds, activity monitoring, and prompt response to call systems. No staff reported any lapses in supervision. LPA interviewed residents. Residents stated they feel safe and adequately supervised. Residents reported staff are available when assistance is needed and respond promptly to requests. None of the residents reported being left unattended or without supervision. OS1 did not express concerns regarding supervision. They stated residents appear well cared for and staff presence is evident during visits. During the visit, LPA observed staff present in common areas and actively engaging with residents. Residents were participating in activities and appeared supervised. No residents were observed unattended in areas that could pose a safety risk. LPA reviewed staff schedules, supervision logs, and facility policies. Documentation confirmed adequate staffing ratios and supervision practices. Based on observations, interviews, and records reviewed, there is insufficient evidence to support the allegation that lack of supervision resulted in a resident being touched inappropriately. Therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Leeda Dost, Administrator. to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Mar 2, 2026 · control 08-AS-20240909090201

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Domingo, made an unannounced visit to conduct the required One-Year Inspection. LPA Domingo was granted entry into the facility by House Manager Maria Lerma, after identifying herself and stating the purpose of the inspection. Leea Dost the Licensee arrived during the visit. According to the facility’s license, the facility serves six ambulatory elderly residents: ages 60 and above. LPA was accompanied by House Manager Maria Lerma, during a tour of the facility, which was conducted inside and out and included a sample of resident bedrooms, common area, dining area. The last disaster drill was conducted in January 2025. Exterior and interior passageways were free from obstructions. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. A fireplace with appropriate screening was observed in the main area of the building. No pools or bodies of water were observed on the premises. Resident’s room temperatures were within a comfortable range. Hot water temperature at taps accessible to residents were all compliant. Each resident had clean and sufficient bed linens, towels, and washcloths. All residents’ rooms were equipped with required furnishings and appropriate lighting to ensure the comfort and safety of residents. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Non-skid mats are present in the showers. Hot water temperature in residents’ bathrooms were compliant. [Continued on 809-C] [Continued on 809] Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food was observed to be properly stored and labeled. Food menus and activities schedule were posted. Medications are locked in a locked closet, not accessible to residents. Medications were labeled and kept in compliance with label instructions. LPA interview with staff indicates the facility is providing assistance to meet necessary incidental medical and dental needs. This includes arranging or assisting in arranging transportation. LPA interviewed staff and a client. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained all required documents. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. No deficiencies were observed or cited. An exit interview was conducted and a copy of this report and Licensee/Appeal Rights - LIC 9058 (rev. 03/22) was provided to the Licensee Leeda Dost, whose signature on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Domingo, made an unannounced visit to conduct the required One-Year Inspection. The residents were all at program and the staff were not available.the state’s words, verbatim · CDSS document, Apr 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection. LPA Rodgers was granted entry into the facility by Care Giver Magida Houaoura, after identifying herself and stating the purpose of the inspection. Administrator Maria Lerma later joined the visit. According to the facility’s license, the facility serves six ambulatory elderly residents: ages 60 and above. LPA was accompanied by Administrator Maria Lerma, during a tour of the facility, which was conducted inside and out and included a sample of resident bedrooms, common area, dining area. The last disaster drill was conducted in January 2024. Exterior and interior passageways were free from obstructions. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. A fireplace with appropriate screening was observed in the main area of the building. No pools or bodies of water were observed on the premises. Resident’s room temperatures were within a comfortable range. Hot water temperature at taps accessible to residents were all compliant. Each resident had clean and sufficient bed linens, towels, and washcloths. All residents’ rooms were equipped with required furnishings and appropriate lighting to ensure the comfort and safety of residents. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Non-skid mats are present in the showers. Hot water temperature in residents’ bathrooms were compliant. [Continued on 809-C] [Continued on 809] Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food was observed to be properly stored and labeled. Food menus and activities schedule were posted. Medications are locked in a locked closet, not accessible to residents. Medications were labeled and kept in compliance with label instructions. LPA interview with staff indicates the facility is providing assistance to meet necessary incidental medical and dental needs. This includes arranging or assisting in arranging transportation. LPA interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained all required documents. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. No deficiencies were observed or cited. An exit interview was conducted and a copy of this report and Licensee/Appeal Rights - LIC 9058 (rev. 01/16) was provided to the Administrator Maria Lerma, whose signature on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 5, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with House Manager Maria Lerma. According to the facility’s license, the facility has a maximum capacity of six (6) clients, all of whom must be ambulatory. During today’s inspection, there were a total of six (6) clients in care, and per medical records, all were ambulatory. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 74 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 103 F, Bathroom #1 sink was 103 F, and Bathroom #2 sink was 103 F. Refrigerator temperature was 35 F and freezer temperature was 0 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. [CONTINUED ON LIC 809C] [CONTINUED FROM LIC 809] No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with House Manager Maria Lerma to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 27, 2023