Mother Mary Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual visit on this date. LPA met with Staff and explained the purpose of the visit. The facility is a single story structure with wheelchair accessibility. LPA observed all required signage prominently posted. LPA toured the facility indoors and outdoors including but not limited to dining room, living room, kitchen, garage, 2 bathrooms, 3 bedrooms and backyard. The facility is licensed for 6 clients. During the tour LPA observed sliding glass door in R1's room blocked by furniture and a stick was placed in the guide-rails of the door preventing it to open. Advisory given. Hot water temperature was measured at 122.5 degrees Fahrenheit in resident's bathroom sink, which is not within the required range of 105 to 120 degrees. Fire extinguishers are current and in compliance with fire safety. Fire drill was conducted on 4/2026. Carbon dioxide monitor present. LPA reviewed 4 resident and 3 staff files, including criminal record clearances. During the resident file review LPA observed orders by the hospice physician for oxygen for R1 ordered on 6/5/2026 not administered. All staff today are associated to the facility. First aid kit was checked and is complete. Deficiencies were cited as a result of today's visit. An exit interview was conducted and a report was left with the facility with appeal rights.the state’s words, verbatim · CDSS document, Jun 11, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87633(d) · Plan of correction due date: Jun 12, 2026

87633 Hospice Care of Terminally Ill Residents (d) The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times. This requirement was not met as evidenced by: Based on interview and record review, Licensee did not ensure R1's oxygen was properly administered as directed on the hospice orders. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 11, 2026

Plan of correction: Administrator will review the regulation being cited today and write a statement acknowledging that the regulation has been read and understood. POC will be emailed to LPA by POC date 06/12/2026 by end of day 5:00 PM.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(e)(2) · Plan of correction due date: Jun 25, 2026

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:Hot water temperature was measured at 122.5 degrees Fahrenheit in resident's bathroom sink, which is not within the required range of 105 to 120 degrees. This is a potential risk to residents in carethe state’s words, verbatim · CDSS document, Jun 11, 2026

Plan of correction: Administrator agrees to adjust the water heater immediately and ensure that the water is within regulation. Administrator will conduct a water temperature check that will include a water log for the rest of the month. The water log will be emailed to LPA by POC date 06/11/26 by end of day 5:00 PM.

Type of visit: Case Management - Deficiencies

On 8/18, at 11:30 pm. Licensing Program Analyst (LPA) Noel Wolf Petersen arrived unannounced to follow up with some changes to policy the facility was asked to make as part of a previous Plan of Corrections. LPA met with the adminstrator Jean Alvarez and explained the purpose of the visit. The issues are addressed as follows. A-Toxics under the sink are now locked in the locked staff room. A- All staff are firgerprinted and associated via gaurdian A- medication training is complete for most employees, current MARs are up to date with available medication, but PRN documentation records are not up to date, the LPA is writing a new citation for it. B- CPR/First Aid is complete, B- 2 days of Perishable Food is in compliance, 7 days of non-perishable is in compliance B- Continuing training is complete for non-dementia folks which the citation was refering to, one resident does have dementia now, therefore extended dementia training is required, and the LPA is writing a new citation for asking that training to be completed. Administrator following documents were reviewed: License: The License is for 6 non-ambulatory, there is one person who is bedridden in the facility currently, and the last fire clearance says 4 non-amb and 2 bedridden, dated 12/6/22. The LPA will ensure the license gets updated and sent to the administrator. Continued on C page Performed a physical inspection and record review of 5 client and 5 staff files. 2 staff interviews and 2 client interviews. Citations issued on following D page An exit interview was conducted, a copy of the appeal rights were left with the administrator, a copy of the report was read and left with the administratorthe state’s words, verbatim · CDSS document, Aug 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(3) · Plan of correction due date: Aug 19, 2025

87465 Incidental Medical and Dental Care (c) ...facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided... (3) A record of each dose is maintained in the resident's record...the date and time the PRN medication was taken, the dosage taken, and the resident's response. The requirement was not met as evidenced by: interview and record review showing multiple 3+ instances of given PRN's without documentation. This constitutes an immediate health and saftey risk to persons in carethe state’s words, verbatim · CDSS document, Aug 18, 2025

Plan of correction: Administrator will send in a picture of documentation demonstration they understand how to document the PRN medication, by the POC.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.626(a)(1) · Plan of correction due date: Sep 18, 2025

California Health and Saftey code 1569.626 (a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff:(1) Twelve hours of dementia care training, six of which shall be completed before a staff member begins independently... All 12 hours shall be devoted to the care of persons with dementia. This requirement was not met as evidinced, by record review. this constiutes a potential health and saftey risk to persons in care.the state’s words, verbatim · CDSS document, Aug 18, 2025

Plan of correction: The Licensee will do a 12h inservice on dementia, then submit a progress report on as 9/18/25, The training should be started for everyone, and at least one person on each shift should be done by 9/18/25.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kesha Lewis and LPM Liza King arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff and administrator joined 30 minutes later. LPA explained the purpose of the visit to Administrator and staff. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 3. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications noted to be locked to residents in care. LPA also conducted the infection control domain tool. A pool is located at the side of the facility gated and locked. Hot water temperature was measured at 110 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point. LPA observed the facility to not have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 04/03/2025 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed three (3) staff files. Not all staff is fingerprint cleared and associated to the facility and No staff have current First Aid or CPR certifications on file. Facility is not conducting initial and continuing training as required. LPA reviewed three (3) resident facility files, COVID-19 Plan, and survey binder. Not all necessary documents were in place. Exit interview held with staff and copies of reports left at conclusion of visit. one residents were present at the facility during the visit.the state’s words, verbatim · CDSS document, Jun 27, 2025

Type of visit: Case Management - Other

LPA Jensen arrived at facility unannounced to conduct a case management. LPA Jensen met with Arvin Alvarez, the son of the Licensee and explained the purpose of the visit. The Licensee previously notified the department that she is not currently taking clients in order to tend to personal matters. The Licensee assisted all residents in relocating and provided the department a resident roster and relocation information. LPA Jensen was granted access to the facility. LPA Jensen inspected all rooms in the facility and verified there are no clients in care. The Licensee will notify the Department when she wishes to resume operations. No further action required by the licensee at this time.the state’s words, verbatim · CDSS document, Nov 8, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1 Year Inspection Visit. LPA met with administrator and explained the purpose of the visit. Administrator Certificate expires 10/26/2025. LPA and administrator toured the physical plant including resident bedrooms, resident bathrooms, and property area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 111.9 degrees Fahrenheit in kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers last inspected 4/1/2024. LPA checked medication storage and found medication to be locked away and inaccessible to residents. First aid kit was checked and is complete. Emergency and disaster drill conducted on 5/1/2024. LPA reviewed four resident files and three staff files, including criminal record clearances. A review of staff records indicates that all staff or other individuals who require caregiver background checks are Fingerprint cleared and but staff 2-3 are not associated or transferred to the facility. Licensee will have staff get fingerprint cleared today and send documentation to LPA Wallace when cleared. LPA verified staff training for staff file reviews. LPA requested the following updated documents for community care licensing to be submitted via email by May 28, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Administrator's Certificate, and Copy of Liability Insurance with expiration date. ruth.wallace@dss.ca.gov Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, see 809-D for deficiency observed or cited today. Immediate civil penalty issued on today's date for both staff. Failure to correct deficiency may result in the additional civil penalties. Exit interview conducted with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.the state’s words, verbatim · CDSS document, May 21, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ruth Wallace arrived unannounced to conduct a case management visit. LPA met with Licensee/Administrator. Administrator holds current Administrator's certificate # 6061970740 which expires March 13, 2024. LPA and Licensee toured the physical plant and grounds. The grounds were observed to be maintained and outdoor furniture in a shaded area is available for resident use. The facility currently has four residents in care. LPA inspected the bedrooms, bathrooms, kitchen, staff quarters and common areas. The thermostat was set at 74 degrees for the comfort of residents in care. Knives, toxins, cleaning supplies were observed to be locked and inaccessible to residents in care. There are currently three bedrooms in use, one room has double occupancy. The other two rooms are private occupancy. The bathrooms were equipped with grab bars in the shower and at the toilet. The water temperature in the main bathroom adjacent to the common area was measured at 110.3 degrees which falls within the required regulatory range of 105-120 degrees Fahrenheit. The facility maintains a two day supply of perishable food and a seven day supply of non-perishable food. There is also an adequate supply of linens. The fire extinguisher was last serviced on April 6, 2023 and is in compliance. The carbon monoxide detector was tested and found to be in working order. The first aid kit was observed to be complete with scissors, tweezers, thermometer, various wound dressings and manual. LPA reviewed three resident files and three staff files. All resident and staff files were determined to be complete and in compliance. Medication Management including destruction of Medication and PRN’s was reviewed. All records in compliance. No deficiencies are being cited from the California Code of Regulations Title 22, Division 6. An exit interview was conducted with licensee. A copy of this report and LIC 811 (Confidential Names).the state’s words, verbatim · CDSS document, Dec 12, 2023