Med Residential Care Home II

Type of visit: Required - 1 Year

12/11/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. There are currently four residents in care. Facility approved/cleared for six non-ambulatory, one bedridden, and hospice waiver approved for two residents. LPA was greeted by staff. Administrator, Matilde Verano arrived shortly after. LPA and administrator toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. LPA and administrator observed a few canned food goods to be expired (Technical Violation). Facility has required postings up. All rooms were furnished per regulation. All rooms were in good repair. Extra hygiene products and linens were available. Bathrooms had appropriate grab bars, non slip mats, and trash cans had tight fitting lids. Water temperature in sinks accessible to residents in care were measured and found to be within the range of 105 to 120 degrees F. Fire extinguishers were last inspected January 2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. LPA observed auditory devices to be in working order. Sharps are located in a locked cabinet in the kitchen. Medications were found to be centrally stored in a locked cabinet in the kitchen. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted a review of 3 resident records. Hospice plans were reviewed and all records had the required documentation. One out of three residents did not have an updated medical assessment. Per conversation with administrator, they have had their yearly medical appointment and have been reaching out to Kaiser Medical Records with no response. continued on LIC809C LPA conducted review of 3 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. Administrator certificate for Matilde Verano is current (09/24/2025 - 09/24/2027) No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/11/2026: LIC500- Personnel Report LIC308- Designation of Responsibility Updated Liability Insurance Exit interview conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 11, 2025

Type of visit: Required - 1 Year

At approximately 9:15AM, Licensing Program Analysts (LPAs) Star Stevenson and Marisol Cuadra made an unannounced annual required inspection of this licensed senior care facility. At approximately 9:40AM Administrator Matilde Verano arrived. At approximately 9:45 AM, LPAs toured the building and grounds which was found to be clean and in good repair, warm and without odors. LPAs observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted in highly visible areas. Facility has the required 2 days of perishable and 72 hours of non-perishable food. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage closet. Water temperature measured within regulation between 105- and 120-degrees F at faucets accessible to residents. Covered trash cans and paper towels were observed in the bathrooms, as well as, extra PPE, and incontinence supplies. Fire extinguishers were inspected and were last charged on 01/2025. Smoke detectors were found to be in working order. Carbon Monoxide detectors were present and working. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. LPAs observed both a bed and couch in the garage with pillows that could make it possible for a staff person or other persons to sleep in the garage. A conversation was held with Administrator Matilde Verano that the bed needs to be removed or stored in a manner that does not allow for persons sleeping there. (Technical Violation was issued) Licensee agrees to submit pictures of the sleeping area removed or stored in such a manner that discourages sleeping. At approximately 10:45AM, LPAs reviewed 5 of 6 resident records and found 5 of 6 residents were in good order including medical assessments and careplans were current as stated by regulation. LPAs reviewed 3 of 6 medication records are thorough, locked and centrally stored and contained physician's orders for each resident. one (1) of six (6) residents are receiving Hospice services and the Hospice care plans were up to date for each resident. Continue on LIC809C At approximately 11:30 PM, LPAs reviewed 5 of 8 staff records. 5 of 8 staff records had required documents, TB clearance and current 1st aide/CPR certifications Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC610E- Disaster Plan Evidence of updated Liability Insurance Updated copy of DEED Updated LIC308 (designation of responsibility) No citations were issued during today’s visit. Exit interview conducted with Administrator Matilde Verano and a copy of this report was given.the state’s words, verbatim · CDSS document, Feb 14, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Personal Rights

Licensing Program Analyst (LPA) Nakagawa arrived unannounced to deliver findings regarding the above allegation on 7/26/2024. It is alleged that staff at the facility are verbally abusive and mistreat Resident (R1). LPA visited the facility on 05/03/2024: conducted interviews and made observations. LPA observed that R1, as well as the other residents in the facility were clean and their needs were being met. LPA observed staff caring for R1 and providing R1 assistance as needed. R1’s room was clean, their bed was made with required linens. LPA observed that the staff on duty addressed R1 respectfully and kindly. R1 stated to LPA that the staff treated them well and was respectful except for Staff (S1). Continued on 9099-C.... Unsubstantiated .....Continued from 9099 LPA interviewed 3 of 5 residents. R2 and R3 stated that the staff never talked to them in any way that was disrespectful or abusive and they did not recall hearing the staff talk to other residents that way. R4 and R5 were sleeping but appeared clean and cared for. LPA interviewed S1 via phone on 05/09/2024. S1 stated that R1 required a maximum of care due to R1’s size and ambulatory status. S1 stated they never referred to R1 or any other resident inappropriately. Based on interviews, documents gathered and observations made, LPA was unable to determine the complainant’s allegation that their personal rights were being violated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Jul 26, 2024 · control 21-AS-20240503081442

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Case Management inspection and met with Matilda Verano, Administrator. LPA is following up regarding resident, R1 who recently passed away but was not on hospice. LPA reviewed documents and spoke with Administrator who provided a timeline of events. Administrator has agreed to provide LPA a copy of the death certificate once it is available. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, May 20, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility on 02/10/2024 to conduct a required annual inspection utilizing the full CARE inspection tool. LPA met with Caregiver who contacted Administrator who arrived to the facility shortly afterwards. LPA explained the purpose of the visit to Caregiver and Administrator. Facility has six residents in care with two residents on hospice services. Facility is licensed for six nonambulatory residents, bedridden clearance for one and hospice waiver approved for one. Based on file review, LPA observed facility has an approved hospice waiver for two. LPA informed Administrator LPA will update facility license and mail to the facility once generated. During today's inspection, LPA and Administrator conducted a tour of the interior and exterior of the facility to ensure the health and safety of residents in care. Areas toured included but not limited to: five resident rooms, bathroom, garage, kitchen, backyard and the common areas. LPA observed the facility to have adequate supply of linens and perishable and non perishable foods. LPA observed knives, medications and toxins to be locked and secured. In areas toured no immediate health, safety, personal rights violation was observed. LPA and Administrator discussed Fire Marshall's upcoming inspection, LPA informed Administrator to inquire for bedridden clearance for two in Room #1. Please continue to LIC 809-C... **LIC 809-C** LPA conducted a file review for R1, R2, S1 and S2. LPA observed the required documents present on file. LPA and Administrator completed the CARE inspection tool and found the facility to be in compliance. No deficiencies observed. At this time, LPA is requesting LIC 500, liability insurance and facility sketch for bedridden to be submitted to LPA Yang by Friday February 16, 2024. Exit interview conducted and a copy of the report and Health Safety Code 1569.625 Staff training; legislative findings; contents will be emailed to Administrator.the state’s words, verbatim · CDSS document, Feb 10, 2024