Maryann Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10AM. LPA met with staff upon arrival and Administrator Mary Ann Howe who arrived at 10:35AM. Entrance interview conducted. At 10:10AM, the LPA along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: LPA inspected the kitchen/food service area at 10:10AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates. Knives and chemicals were locked and inaccessible in the cabinet under the sink. LPA observed emergency food supply. BEDROOMS: There are three (3) bedrooms total; two (2) are shared-resident bedrooms, and one (1) is a single-resident room. LPA did not observe a staff bedroom. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. LPA observed half bed rails equipped for each resident. Upon record review, half rail orders for residents’ were missing. RESTROOMS: There are two (2) restrooms total; one (1) is for resident use and one (1) is for staff use. Restrooms were clean, sanitary, and in operating condition with grab bars and slip-resistant surfaces. Hot water in resident restroom measured at 111.6 degrees F, which is within the required range. Report Continued on LIC 809-C. COMMON SPACES: This includes the living room and dining area. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Living room contained a fireplace that was adequately screened. The LPA observed the required postings in the common hallway. Fire extinguishers were fully charged and last serviced 05/19/2026. The facility smoke alarm system is hard wired; the combination smoke and carbon monoxide detectors were tested at 10:26AM and were operable at the time of the visit. OUTDOOR AREA/GARAGE: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water. Passageways were free and clear from obstruction. LPA observed a locked garage containing a washer and dryer, additional refrigerator, and emergency water supply. MEDICATION REVIEW: At 10:30AM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in the hallway closet. All medications including PRNs were labeled, stored, and locked inaccessible to residents. All medications reviewed were properly documented and accounted for; no errors observed. RECORD REVIEW: Beginning at 12:43PM, LPA reviewed five (5) out of five (5) resident files and four (4) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training, first aid certification, and fingerprint clearance. LPA observed five (5) out of five (5) residents with half rails equipped on their beds and no half rails orders. Administrator stated she will obtain written orders for the half rails. Personnel files were complete and in compliance with Title 22 regulations at the time of the visit. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 06/27/2026. All documents reviewed were updated and in compliance. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Administrator was informed that failure to correct deficiency may result in civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 28, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Angela Barutyan conducted a pre-licensing visit to the facility noted above at 10:32AM. LPA met with Applicant Mary Ann Howe. The applicant has obtained fire clearance for a total capacity of six (6) residents. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The facility is a single-story home. The facility has three (3) resident bedrooms for shared-use. All resident bedrooms are cleared for non-ambulatory. The hard-wired smoke alarms and carbon monoxide detectors were tested and function properly. LPA observed fire extinguisher to be fully charged and last serviced 07/17/2024. LPA toured the kitchen area at approximately 10:35AM. At 10:37AM, hot water temperature was measured in the kitchen sink and was 121.2 degrees F. Water heater was lowered during the visit. LPA remeasured hot water at 10:48AM and measured at 110.1 degrees F. Appliances and all equipment appeared to be clean and in good repair. The kitchen has a sufficient supply of plates, cups, cookware, and utensils. Knives, sharps, and cleaning solutions were locked in a cabinet under the sink. LPA observed emergency food and water supply in the kitchen. Resident bedrooms are equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a sufficient supply of linens, including blankets, bath towels and wash cloths. LPA observed Bedroom #3 with direct exit to the exterior and an adequately screened fireplace. The facility has two (2) bathrooms located in the hallway. One (1) is for resident and visitor use and one (1) is for staff use. Bathrooms contained appropriate slip-resistant surfaces and grab bars. Hot water temperature was measured in bathrooms and were between 107.5-108.1 degrees F, which is within the required range. Report Continued on LIC 809C... Report Continued from LIC 809C... The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. LPA observed enough seating for six (6) residents at the same time. A working telephone is present. There are activity supplies. There is one (1) fireplace in the living room and was observed adequately screened. Night-lights were present in the hallways. Medications will be stored and locked in a closet by the living room. LPA observed a complete first aid kit in the medication closet. Facility records will be kept in a cabinet in the living room. Additional cleaning supplies, toxins, a washer and dryer, detergents, and disinfectants were observed in the detached garage which is kept locked. There will be no firearms/ammunition stored on the property. The facility has required postings, including Emergency Exit Plan, Resident Personal Rights, and Theft and Loss Policy. Outdoor passageways were free of obstructions. There are no bodies of water on the premises at the time of the visit. LPA observed an outdoor area with a table and chairs for client use. All exits had functioning auditory exit alarms. Physical plant is consistent with the submitted facility sketch/floor plan. Comp III conducted with Applicant. Pre-Licensing is complete and this facility has no deficiencies. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. The report was reviewed, and a copy was provided.the state’s words, verbatim · CDSS document, Jun 10, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Howe, Mary Ann On 5/21/25, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 21, 2025