Meridian Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Staff#1 upon arrival and Administrator Ewa Nyczak join shortly after. LPA explained the reason for the visit to Administrator. Facility annual fees are current. The facility is licensed to serve six (6) elderly clients ages 60 and above with a hospice waiver for three (3) residents. Dementia waiver is in place. Today’s inspection consisted of applying CARE tool, conducting physical plant, reviewing staff/residents records, checking residents’ food supply/medication, and interviewing staff/residents. Infection Control: Facility maintains an infection control plan was on file. Staff were observed practicing safe hand washing. Hand sanitizing was observed throughout. Hygiene supply and sanitizing materials were observed. (-continued on LIC 809C) Physical Plant & Environmental Safety: The facility is a single story home located in a residential neighborhood and consists of four (4) resident bedrooms, two (2) bathrooms, a living room, a dining room, a kitchen, a laundry area, a sun room, a detached garage, front sitting area, and a back yard. Physical plant tour was conducted and observed the facility is in good repair in general. Facility is operating within capacity. Outdoor space is furnished, shaded, and accessible to residents. Passageways and exit areas were observed free of obstructions. Restrooms were observed clean. Water temperature was tested within 115 - 118.5 degrees F., which is within the required 105-120 degrees F per Title 22 requirement. Staff/ Residents Records review: Administrator certificate is current, and the expiration date is 9/22/26. Staff and residents’ records were available to review. Food Service: The kitchen was clean. The required two (2) days of perishable and seven (7) days of nonperishable were observed and stored separately from toxic/cleaning supply. Health-Related Services: Medications are centralized stored. Disaster Preparedness: Emergency Disaster Plan LIC610E was observed and last reviewed on 2/07/25. A contingency plan was observed. Last emergency drill was conducted on 12/24/26. (-continued on LIC 809C) Exit: Deficiencies were noted during this visit and cited per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Staff#1 and LIC 809s and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 3, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Emerlinda Esguerra Caregiver and explained the reason for the visit. The facility is licensed to serve (6) elderly clients ages 60 and above with a hospice waiver for (3) residents. The facility is a single story home located in a residential neighborhood and has (4) resident bedrooms, (2) bathrooms, a living room, a dining room, a kitchen equipped with a laundry area, a sun room, a detached garage, front sitting area, and a back yard. LPA reviewed the following CARE inspection tool domains during this visit: Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation was observed during the visit. One staff does not have a TB test clearance on file. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed. Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license. Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Emerlinda Esguerra and observed the following: Facility was observed in good repair indoors and outdoors. Living room/dining room are clean, and providing sufficient sitting area, and lighting. Kitchen area is clean, sharps were observed locked in a drawer. Medications were observed in a drawer unlocked. Cleaning supplies were observed unlocked. Laundry area was observed in good repair. (CONTINUED ON LIC 809C) Four (4) resident rooms were observed clean with sufficient lighting, furniture, and bedding supplies. Full bed rails were observed in bedroom #2. One (1) Bathroom was observed clean in working condition with grab bars and skid mats in the showers. Water temperature was tested at 105.8 degrees F., which is within the required 105-120 degrees F. Sun room was observed clean and furnished. Activities were observed in sun room. Front yard and back yard have a shaded seating area. Garage is used to stored additional food and cleaning supplies stored properly. There are no large bodies of water in the facility. Carbon Monoxide/Smoke detectors were observed, tested, and in working condition. Fire extinguishers were observed and last checked on 1/15/21. Ramps, exit doors, and passageways are free of debris and obstructions. Staffing: Administrator Ewa Knyczak arrived at the facility shortly after. Staff have current CPR/First Aid training on file. Night staff have been provided emergency training. Sufficient staff were observed. Personnel Records/Staff Training: Administrator certificate was observed for Ewa Knyczak #7006214740 exp. date: 9/22/26. All staff records were available for review. LPA reviewed a total of 4 staff files which included medical assessment, TB clearance, background clearance, and training. One (1) staff was missing a health screening/TB clearance. Staff training files were not on file for the last 20 hours of yearly training. Resident Rights/Information: Personal Rights, Let Us No poster (PUB 345), and Local Ombudsman posters were observed throughout the home. Planned Activities: Activity materials were observed. One (1) resident was observed involved in activities during the visit. Outdoor area has a seating area to promote outdoor activities. Food Service: Sufficient food supplies were observed of perishables for at least 2 days and non-perishables for at least 7 days. There are currently no residents on special diets. No pest was observed. Incidental Medical and Dental: There is an area designated to centrally stored medication in a cabinet with a lock in the kitchen. LPA observed some medications in unlocked kitchen cabinets. Medications are label and in their original containers. Resident Records/Incident Reports: Residents records were available for review. LPA reviewed a total of 5 resident files which contained medical assessment, TB clearance, admission agreement, an appraisal, a needs and care plan. Disaster Preparedness: Emergency Disaster plan (LIC 610D 3/19) was last reviewed on 3/15/25. Last Emergency drill was conducted on 3/1/24 quarterly emergency drills have not been conducted since last. (CONTINUED ON LIC 809C) Residents with Special Health Needs: Postural support/bed rails were observed and physician's request were observed in residents files under hospice. There are no residents with restricted health conditions under care. Facility is following dementia regulations. Medical assessments for residents with dementia were observed within the last 12 months. Auditory devices were observed in each exit door. Facility currently has two resident on hospice and keeps hospice plan on file. Deficiencies were noted per Title 22 Regulations and a technical violation was noted. Exit interview was conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2025

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Virginia Aguinaldo and explained the reason for the visit. The facility is a single story home located in a residential neighborhood and has (4) resident bedrooms, (2) bathrooms, a living room, a dining room, a kitchen equipped with a laundry area, a sun room, a detached garage, a covered front sitting area, and a back yard. Facility does not have large bodies of water. LPA Flores toured the facility with Virginia Aguinaldo and observed the following: Facility is in good repair indoor and outdoor. Living/dining/sun room have sufficient furniture that are in good repair. Kitchen was observed clean, sharps are locked in a drawer. Medication cups (prepared) were observed on top on counter top next to the refrigerator, hospice medication was observed in the freezer and a liquid medicine was observed in refrigerator door accessible to the residents and not properly stored. Sufficient food supplies were observed worth of at least 2 days of perishables and 7 days of non-perishables. Cleaning supplies were observed in cabinet inaccessible. Each resident room (4) was observed with sufficient lighting, furniture, and bedding supplies. Resident #2(R2) is in hospice and has full bed rails in bed. Bathrooms (2) were observed clean, and in working condition, a bottle of cleaning solution was observed in bathroom #1(B1) accessible to the residents. Water temperature was tested in each bathroom and tested between 106.8- 107.1 degrees F., which is within the required 105-120 degrees F. Front and back yard are clean and have a shaded seating area. LPA reviewed 4 residents medication and files. R2 does not have a bed rail request on file. Resident #3(R3) does not have a physician's report on file. Four residents are on hospice, facility has a hospice waiver for three only, facility is not operating within the license. LPA reviewed 5 staff files. Administrator certificate was observed for Ewa Nyczak #6020655746 exp: 9/22/24. Training was provided to staff. (CONTINUED ON LIC 809C) Infection Control plan, and Emergency Disaster plan (7/27/23) were reviewed. Let us Know PUB 475 poster was not observed posted at the facility. Exit interview was conducted with Virginia Anguinaldo and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 5, 2024

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.