Minona Garden Residential Senior Care

Type of visit: Required - 1 Year

On 7/30/2026 at 2:30 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with caregiver Ana Delgado and was granted entry to the facility. At the time of the visit there was one (1) staff present, and six (6) residents present. The facility was a one (1) story house with four (4) resident bedrooms and two (2) bathrooms, living room, dining area/kitchen and laundry. There was an attached two (2) car garage in the left side of the house. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory and waiver/granted for two (2) hospice care LPA was accompanied by Staff to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 115.8 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Three (3) fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. d. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPA observed complete first aid kit and first aid book at the facility. Yards/Outside: One shaded patio, two (2) side gates with self-latching handle on both side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstruction. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed resident files reviewed were complete. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. No issues observed. Medications/Medication Administration Record (MAR) were audited, no issues observed Based on the observations made during today’s visit, No deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, were discussed and provided to Administrator Elizabeth Colunga who later arrived.the state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Prelicensing

On 7/10/2025 at 08:50 AM, Licensing Program Analyst (LPA) Eldin Serrano conducted an announced visit to the facility for purpose of Prelicensing evaluation. LPA met with Applicant/Administrator Elizabeth Colunga. An initial application to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 06/05/2024 for a total capacity of six (6) of which six (6) can be nonambulatory and two (2) hospice care waiver. Fire clearance was granted on 09/19/2024 for six (6) non-ambulatory residents. LPA Serrano observed the following: Structure: Facility was a one (1) story house with four (4) resident bedrooms and two (2) bathrooms, living room, dining area/kitchen and laundry. There was an attached two (2) car garage in the left side of the house. Heating/Cooling System: Central heating and air conditioning system installed with one (1) central panel located in the hallway to control entire house. Bedrooms: Each resident bedrooms accommodate any nonambulatory residents. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, nightstands, a lamp and an operable smoke/carbon monoxide alarm. Bathrooms: The two (2) resident/staff bathrooms have a working toilet, wash basin, grab bars, non-slip mat and shower with an adequate supply of toilet paper and soap. LPA Serrano tested the water temperatures in the residents' bathrooms. ***CONTINUED ON LIC 809-C*** ***CONTINUED FROM LIC 809*** LPA Serrano verified water temperature was measured at 107.7 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA Serrano observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was in the laundry room. Laundry detergents and cleaning supplies were observed in a locked cabinet. Garage door is locked away from residents. Living Room: There was a living/family room with adequate seating for all clients and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the restroom of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Self-latching handle gate on both side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted near the main entrance. There was Let-Us-No poster, Ombudsman Poster. Dementia Care Plan: LPA Serrano observed and reviewed the Dementia Care Plan during the visit. General items: Three (3) fire extinguisher was charged and located in the kitchen, hallway, laundry room. eight (8) smoke detectors and two (2) carbon monoxide detectors were tested and were observed to be in working order. Resident records and staff records will be stored in a locked cabinet in the family room. First Aid kit with required components, First Aid Book and locked area for medication storage was observed. ***CONTINUED ON LIC 809-C*** ***CONTINUED FROM LIC 809*** LPA observed a facility phone and was operational as evidenced by LPA dialing the number. The phone number designated for the facility is 909-222-4795. There is enough Emergency water supply and the required 72-hour emergency food supply for residents and staffs available at the facility. Component III was completed on this day as well. Additionally, LPA Serrano observed facility having Visitor Sign In/Sign Out Sheet and Client Sign In/Sign Out Sheet, upon entering facility. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Applicant/Administrator Elizabeth Colunga.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Elizabeth Colunga, LLC Member/Administrator Interview Method: Telephone interview On 6/12/25, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. 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, Jun 12, 2025