Mt. Vernon Gardens

Type of visit: Post Licensing

Licensing Program Analyst (LPA), Marisol Cuadra arrived unannounced for the purpose of conducting a Post-Licensing inspection and met with Licensee, Emilce Deller. Facility currently does have residents in care and has a dementia care plan. Also, the facility has approval for a hospice waiver for two residents. Licensee submitted proof of required liability insurance. The facility received a fire clearance approval on 4/10/2026 by the Fire Department for five non-ambulatory residents, one bedridden in room #4 for a total of six residents. LPA/Staff toured the building and grounds. The facility was at comfortable temperature. All resident rooms are furnished per regulation. Pantry and utility area storages cleaning supplies, incontinence care supplies and emergency supply of water. Office has locked cabinets storages medication and file. Auditory alarms are working properly. There are two generators. Water temperatures read at: 106.1 degrees F which is within regulation. Bathrooms have grab bars and skid mats available. Kitchen cabinets were locked and secured. Smoke and carbon monoxide detectors were operational. Fire extinguishers serviced on January 2026. LPA conducted file review at 9:00am: Five out of five residents have current medical assessments and care plans. Admission Agreements where updated including surveillance cameras presence without audio. Three out of three staff has current CPR/1st aid certifications and training hours required on file. Required postings. Administrator certificate for administrator Emilce Deller, 7035961740, expires on 2/26/28. No deficiencies were cited during Post-Licensing inspection. Exit interview conducted with staff, and a copy of this report was given.the state’s words, verbatim · CDSS document, Sep 16, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Cuadra arrived announced to conduct a pre-licensing inspection and was greeted by Applicant, Emilce Deller. Facility currently does have residents in care and has a dementia care plan. Once obtained, Applicant will submit proof of required liability insurance. The facility consists of a single story residence with a total of six single occupancy bedrooms, three full bathrooms, one half bathroom, office, laundry room located in the utility room, kitchen, dining room, garage and living room as common areas. Hospice waiver for two residents. The facility received a fire clearance approval on 4/10/2026 by the Gold Ridge Fire Protection District for five (5) non-ambulatory residents, and one (1) bedridden in room #4 for a total of six residents. The fire clearance doesn't include approval for delayed egress. Administrator certificate for administrator Emilce Deller, 7035961740, expires on 2/26/28. At approximately 9:15am LPA/Applicant toured the building and grounds. The facility was found to be at a comfortable temperature. All resident rooms are furnished per regulation with bed, lamp, bedside table, dressers and chairs. Pantry and utility area houses laundry, cleaning supplies, incontinence care supplies and emergency supply of water. Office has locked cabinets that are used for medication and file storage. There are auditory alarms installed at the doors that were tested and operational during the visit. There are two generators. Emergency and night lighting are present. Water temperatures read at: 111 degrees F which is within 105-120 F degrees regulation. Bathrooms have grab bars and skid mats available. Kitchen cabinet has locks for knives to be inaccessible to residents in care. Smoke and carbon monoxide detectors present and functioning. Fire extinguishers serviced on January 2026. Admission Agreements will be updated including surveillance cameras presence without audio. LPA observed all required postings including the CCL Complaint Poster, Long Term Care Ombudsman Poster, Resident's Rights, and the rights to Resident and Family Councils. Applicant has satisfied all requirements in accordance with Title 22 Regulations including Component III. LPA will notify Application Unit Pre-licensing inspection is complete to proceed with the process of license. Exit interview conducted with Applicant and copy of this report was given.the state’s words, verbatim · CDSS document, Jun 29, 2026

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Jun 2, 2026