Mira Vista Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Elizabeth Franco, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there were one (1) staff member and two (2) residents present. Facility Overview: The facility is a one-story home with six (6) bedrooms and five (5) bathrooms, including an attached garage. There are no known firearms on the premises. There is a fenced swimming pool with locked gate. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 120°F. Fully charged fire extinguisher located at dining area has year 2025 stamp on the bottom. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for four (4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Two (2) out of four (4) staff did not have valid CPR/First Aid certification. A citation was issued. Two (2) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for two (2) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the emergency/disaster drill conducted on 06-02-2025. All facility exits were clear of obstructions. One (1) deficiency was issued during the visit. An exit interview was conducted, during which this report was reviewed and provided along with LIC809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Administrator came during the inspection. Resident record review began- Five (5) records were reviewed. LPA reviewed for admission agreement, medical assessment-unable to verify 1 resident and TB test results, consent forms-1 missing, identification and emergency information-1 missing, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is not meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 113.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued on Page 1) LPA began review of employee records- Two (2) records were reviewed. LPA reviewed employee record for first aid certification-1 record unable to verify, fingerprint clearance-1 record unable to verify, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 08/2024. LPA is unable to verify if the facility is conducting emergency disaster drills as documentation was requested and could not be provided during the inspection. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there are four (4) deficiencies is being cited per Title 22, Division 6 of The California Code of Regulations. This report, 809D and appeal rights was reviewed with and a copy provided to the facility representative. Appeal Rights were also provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Aug 23, 2024