Melrose Care Home II

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted a case management visit in conjunction with an annual visit. LPA met with Lilia Rena, Administrator During the visit, LPA discussed with Administrator Rena the requirements to submit for a hospice waiver. Rena stated that she will submit the waiver request this year to have it ready when one of the residents is under service care. LPA provided the Title 22 regulation pertaining to hospice service. The administrator signature is confirmation of receipt of this report.the state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to conduct a 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 Administrator Lilia Rena. According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be non-ambulatory, but none may be bedridden. During today’s inspection, there were a total of four (4) residents in care, of whom all were non-ambulatory, but none were bedridden. The facility’s license does not include endorsements for delayed-egress doors or secured perimeters, and none of these were present. LPA, accompanied by Rena, toured the interior and exterior of the facility and inspected all common areas and resident bedrooms. LPA interviewed multiple residents and multiple staff. LPA reviewed care records for all residents and personnel records for all active staff. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 74 F. Hot water temperature at taps accessible to residents were all compliant. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] Appliances to preserve perishable food were also compliant in temperature. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. No fireplaces or pools/bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detector, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher had been professionally inspected within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. Fire/disaster drills were performed at required intervals. There were reserve supplies of Personal Protective Equipment (PPE) and staff were trained on PPE within the last twelve (12) months. Licensee presented proof of current business liability insurance good 11/2026. During facility tour, LPA observed, and manager interview confirmed: The facility’s manual fire alarm pull station and bell alarm had not been inspected/serviced within the last twelve (12) months. Two (2) of six (6) smoke detectors were working. These items were necessary to maintain ongoing compliance with the facility’s prior approved Fire Clearance. During records review, LPA observed no exceptions noted. Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the LIC809-D page). Plans of Correction were jointly developed with the Licensee. No deficiencies were issued during today's visit. An exit interview was conducted with Licensee/Administrator Lilia Rena, to whom a copy of this report, the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee/Administrator Lilia Rena. According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of four (4) residents in care, of whom one (1) was ambulatory and three (3) were non-ambulatory, but none were bedridden. The facility’s license does not include endorsements for delayed-egress doors or secured perimeters, and none of these were present. LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility and inspected all common areas and resident bedrooms. LPA interviewed multiple residents and multiple staff. LPA reviewed care records for all residents and personnel records for all active staff. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 74 F. Where tested, hot water temperature at taps accessible to residents were all compliant: Kitchen Sink was 113 F, Bathroom #1 Sink was 112.5 F, and Bathroom #2 Sink was 114.1 F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] Appliances to preserve perishable food were also compliant in temperature. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. No fireplaces or pools/bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detector, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher had been professionally inspected within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. Fire/disaster drills were performed at required intervals. There were reserve supplies of Personal Protective Equipment (PPE) and staff were trained on PPE within the last twelve (12) months. Licensee presented proof of current business liability insurance. During facility tour, LPA observed, and manager interview confirmed: The facility’s manual fire alarm pull station and bell alarm had not been inspected/serviced within the last twelve (12) months. Two (2) of six (6) smoke detectors were initally non-working. [During today's visit, Licensee inserted fresh batteries into both smoke detectors, correcting the problem.] These items were necessary to maintain ongoing compliance with the facility’s prior approved Fire Clearance. During records review, LPA observed, and manager interview confirmed: Licensee did not record the name, address, and telephone number of a primary dentist for 4 of 4 clients [Client #1 (C1) through Client #4 (C4)], as required. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the LIC809-D page). Plans of Correction were jointly developed with the Licensee. LPA also issued one (1) Technical Violation (TV) regarding a videoconferencing device dedicated for resident use (refer to the LIC9102-TV page), and Technical Assistance (TA) regarding staff alert devices on exit doors and refresher training on Mandated Reporting requirements for staff (refer to the LIC9102-TA pages). An exit interview was conducted with Licensee/Administrator Lilia Rena, to whom a copy of this report, the LIC 809-D page, the LIC9102-TV page, the LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Jul 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Lilia Rena. According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation and review of each resident’s latest LIC602 Physician’s Report: During today’s visit, there were a total of three (3) clients in care, and none were bedridden. This facility’s license does not include endorsements for secured perimeter or delayed egress doors, and none of these were present during the visit. During today’s visit, LPA interviewed multiple staff and residents. LPA reviewed all staff and resident records/files. 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 general good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 73 F. Hot water temperature at taps accessible to residents were all compliant: Kitchen Sink was 111.1 F, Bathroom #1 Sink was 111.6 F, and Bathroom #2 Sink was 112.1 F. Appliances to preserve perishable food were also compliant in temperature: Kitchen Refrigerator was 31 F and Kitchen Freezer was 0 F. Garage Refrigerator was 39 F and Garage Freezers were 0 F and 0 F, respectively. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] There were no sharp objects, toxic chemicals/poisons, active fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. No pools or bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detector, smoke detectors, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher was serviced within the last twelve (12) months. A complete first aid kit was present and readily accessible. Required licensing postings were observed in visible areas of the facility. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance. During records review, LPA observed, and staff interviews confirmed: Resident #1 (R1) had an as-needed (PRN) medication made available to them by their doctor. [See LIC811 Confidential Names List for a description of resident identifiers used in this report.] Staff had given R1 this PRN medication often, prior to LPA’s 07-10-2024 visit. However, the staff assisting R1 did not record in writing the date, time, dosage, and the resident’s response to doses of this PRN which were given to them, as was required. For R1, Resident #2 (R2), and Resident #3 (R3), Licensee had not prepared a written record of care (i.e., a “care plan”) describing the services the resident will receive in the facility and the resident’s preferences, which was required to be done within two (2) weeks of admission to the facility. Because these care plans did not exist for R1, R2, and R3, those residents’ respective responsible persons (RPs) also did not have the opportunity to meet with Licensee to review them (which was required to be done at least annually). The latest LIC603 Resident Appraisals which Licensee had conducted on R1, R2, and R3 were all more than one year old. (Regulation required these residents’ condition to be reappraised upon any change in condition, but also at least annually.) For R3, Licensee did not have a record of body weight measurement for them. For R1, it had been over seventeen (17) months since Licensee last obtained a body weight measurement for them. For R3, it had been over sixteen (16) months since Licensee last obtained a body weight measurement for them. (Regulation required Licensee to “regularly observe” residents for changes in physical condition, to include “unusual weight gains or losses.”) [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] LPA also observed, and Licensee interview confirmed: Licensee did not perform emergency/disaster drills with the staff and/or residents. (Regulation required each shift to be drilled at least once per quarter). Licensee did have proof that 4 of 4 staff were trained on its written LIC610 Emergency Disaster Plan and the staff’s individual roles/responsibilities under this plan. (Regulation required staff to be trained on the plan at time of hire and at least once per year thereafter). Licensee did not have proof that 4 of 4 staff received training on the use of Personal Protective Equipment (PPE). (Regulation required staff to be trained on PPE annually.) Licensee also did not have proof that 4 of 4 staff received training on Resident’s Personal Rights described in law. (Regulation required staff to be trained on this topic initially and on an ongoing basis). Five (5) deficiencies were cited per California Code of Regulations, Title 22, and three (3) deficiencies were cited per California Health and Safety Code (refer to the attached LIC 809-D pages). Plans of Correction were jointly developed with the Licensee. LPA issued two (2) Technical Violations (TVs) regarding physician-authorized medication lists and night lights in bathrooms and hallways (refer to the attached LIC9102-TV pages). LPA also provided Technical Assistance (TA) regarding obtaining updated medical assessments for residents, and regarding staff auditory alert devices on exit doors (refer to the attached LIC 9102-TA page). An exit interview was conducted with Rena, to whom a copy of this report, the LIC 809-D pages, the LIC9102-TV pages, LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Jul 10, 2024