Mt. Sherrod Home

Type of visit: Required - 1 Year

On November 25, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley introduced self and was granted entry into the facility by staff, after stating the purpose of the visit. Administrator (AD) Joey Encarnacion arrived at the facility and remained to assist during the visit. The facility is licensed to operate for six (6) non-ambulatory residents, of which one (1) may be bedridden with a hospice waiver for six (6) residents. The facility is a one-story house with five (5) resident bedrooms, two (2) staff bedrooms, two (2) bathrooms, living room, dining room, kitchen, an attached 2 car garage, and an outdoor covered seating area. During the visit, LPA toured inside and outside of the physical plant with staff. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be clean and operational. The water temperatures measured between 116.2 degrees F to 116.7 degrees F. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. LPA toured the backyard and observed a shaded seating area with tables and chairs for residents to sit outside. Continues on LIC 809-C... The smoke detectors and carbon monoxide detectors were observed operable. Emergency safety drills were last conducted on September 7, 2025 and are conducted quarterly. First aid kit is maintained and contains all the necessary elements. A working telephone (714)839-4417 remains available, however, the facility does not have a device that can be used for video teleconference purposes. Emergency food, emergency water, and emergency supplies were stored in the garage. The facility has two (2) fire extinguishers that were charged, mounted, and serviced on September 2, 2025. Liability Insurance is effective June 1, 2025 and expires on June 1, 2026. LPA conducted an audit of six (6) resident files (R1-R6), five (5) staff files (S1-S5), and medication and medication administration review. Resident and staff interviews were conducted. No Deficiencies were cited during the time of the visit. An exit interview was conducted, and a copy of this report was provided to Administrator Joey Encarnacion at exit.the state’s words, verbatim · CDSS document, Nov 25, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1. During today’s visit, LPA met with Geraldine Lasala Doan, Administrator (AD). The facility is a single story building with an approved fire clearance of six non-ambulatory residents of which one may be bedridden and is approved with a hospice waiver for six residents. The facility currently has a census of six residents in care with three on hospice. There are five private bedrooms and one shared bedroom. At 8:40 AM LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured 119.4 degrees Fahrenheit in both bathrooms and all smoke and carbon monoxide detectors were operational. The fire extinguishers are charged and were serviced on August 5, 2024. The facility’s last fire drill was conducted on September 13, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications at 10 AM. The First Aid Kit had all of the required elements with a FIrst Aid Manual. Per review medications are being given as prescribed. At 10:30 AM LPA observed three residents doing chair exercises with Staff #2. The outdoor area had a shaded area and all outdoor exit gates were self-closing. There were no obstacles or hazards observed. (Continued on LIC 809) (Continued from LIC 809) LPA reviewed three of three staff training and fingerprint records and a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a pending renewal administrator certificate which will expire on August 16, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Staff #1 and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Oct 30, 2024

Allegation investigated: -Staff were under the influence of drugs. -Resident was illegally evicted.

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose to conduct additional interviews and deliver findings regarding allegations listed above. LPA Quiroz was greeted by Caregiver 1 (CG1). Licensee (L) Thi Doan and Administrator (AD) Geraldine Doan arrived shortly after and discussed purpose of today's visit. The 10-day inspection visit was conducted by LPA Quiroz on 3/15/2022 and complaint follow up inspection visits were conducted on December 8, 2023 and March 28, 2024. During the course of the investigation, LPA Quiroz conducted interviews with interviewees consisting of staff and residents. LPA Quiroz conducted documentation review of resident roster, staff roster, physician reports, identification forms and Client/Resident Personal Property and Valuables for Resident 1 (R1) and Resident 2 (R2). Regarding the allegation "Staff were under the influence,” the investigation revealed the following, LPA Quiroz interviewed staff and residents. Six of six staff and three of six residents denied the allegation indicating no knowledge of staff being under the influence of drugs in the facility. CONTINUED... Unsubstantiated LPA Quiroz conducted facility inspection visits on: March 15,2022, December 8,82023 and March 28, 2024 and did not observe staff to be under the influence of drugs and alcohol. On February 7, 2022, the Responsible Party of R1 and R2 packed their belongings. The LIC 621 Clients/Residents Personal Property and Valuables showed all items packed and taken at the time of discharge. Former Administrator went over the items with the responsible party who signed the document acknowledging items received. At that time no drug paraphernalia was observed to be present with the belongings. Regarding the allegation "Resident was illegally evicted," the investigation revealed the following: Interviews conducted with (L) Thi Doan and (AD) Geraldine Doan and documentation review of Client/Resident Personal Property and Valuables for (R1) and (R2) concluded (R1) and (R2) were discharged from the facility on February 7, 2022 per responsible party’s decision. (AD) Doan indicated (R1) was transferred to hospital on January 4, 2022 and transferred to skilled nursing facility on Decmebr 12,2022 due to higher level of care needs. (AD) Doan indicated (R1s) responsible party was reimbursed for (R1s) room share with a total of $2308.08. Although a 30-day notice was verbally given by responsible party, there was no written follow up by either Facility Representative or Responsible Party. However, a refund was still issued to responsible party. (AD) Doan indicated (R2) was transferred to Emergency room on January 31, 2022 and then transferred to skilled nursing facility due to higher level of care needs. (AD) Doan received a check in the amount of $2,650 on January 29, 2022 for (R2s) room share cost . (R2) left to the hospital on January 31,2022 and never returned. (AD) Doan did not cash the check and returned the check on January 31, 2022. (AD) Doan called (R2s) responsible party who stated (R2) would not be returning to the facility and would remain at Skilled nursing facility. Documentation review of Client/Resident Personal Property and Valuables for (R1) and (R2) note signature signed by responsible party on date February 7, 2022. Therefore based on the preponderance of evidence gathered through interviews, observations conducted by LPA Quiroz and documentation review, the allegations that the "Staff were under the influence of drugs” and “Resident was illegally evicted” are deemed UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. This agency has investigated this complaint. No deficiencies cited during today's visit. An exit interview was conducted with (L) Thi Doan and (AD) Geraldine Doan and a copy of report and LIC 811-Confidential Names were provided at exit.the state’s words, verbatim · CDSS document, Mar 28, 2024 · control 22-AS-20220307154845

Allegation investigated: -Staff will not provide resident's doctor with history of care.

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose to conduct additional interviews, review documentation and deliver findings for complaint allegation listed above. LPA Quiroz was greeted and granted entry by Caregiver Jovita Manaloto and called and spoke to Administrator (AD) Geraldine Lasala-Doan via telephone and discussed purpose of today's visit. (AD) Geraldine Lasala-Doan arrived during today's visit. The 10 day visit was conducted on 8/02/2021 by LPA Joseph Alejandre. During the course of the investigation, LPA Quiroz and LPA Alejandre conducted interviews with interviewees consisting of staff and witness. LPA Quiroz also conducted documentation review but not limited to resident roster, staff roster, physician report, identification form, needs and services plan and Admission Agreement for Resident 1 (R1) and Resident 2 (R2). Regarding the allegation, "Staff will not provide resident's doctor with history of care" the investigation revealed the following: Interviewee interviewed indicated that requested information was received as requested from the Hospice company and that information was forwarded it to the new doctor. CONT... Unfounded CONTINUED... Witness indicated that the facility was not involved in the information exchange and that the facility has never withheld anything requested from (R1), (R2) and Responsible Party. In addition, the investigation revealed that the responsible party for (R1) and (R2) is the only person who is allowed to make decisions for (R1) and (R2) and the only person allowed to release or have access to their information other than the facility and the doctors. Therefore based on the preponderance of evidence gathered through interviews and documentation review, the allegations that the "Staff will not provide resident's doctor with history of care" is deemed UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint. No deficiencies cited during today's visit. An exit interview was conducted with (AD) Geraldine Lasala-Doan and a copy of this report and LIC 811- Confidential Names were provided at exit.the state’s words, verbatim · CDSS document, Dec 8, 2023 · control 22-AS-20210723122920