My Place

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to complete annual inspection. LPA met with Arlene Ferguson during today's inspection. Currently there are 3 residents residing in facility and 1 resident receiving hospice services. LPA toured facility with administrator to ensure health and safety of residents in care. LPA toured 5 resident rooms, 1 staff room, 2 bathrooms, kitchen, common living spaces, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA toured the backyard and all exits are accessible and unlocked. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed an adequate amount of linens and found the first aid kit to be complete. Hot water temperature was measured at 117 degrees. LPA reviewed 2 of 3 resident files and 2 staff files. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates and training completed. LPA observed a copy of current liability insurance. No deficiencies are being cited as a result of todays inspection. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 12, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Cassandra Mikkelson arrived at the facility and met with Administrator, Vanla Peters, to conduct a Pre- Licensing visit. The facility has a fire clearance for six (6) non-ambulatory residents. Administrator has an active certificate (#7027076740 with expiration date 12/01/2025). LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and one (1) bathroom for resident use. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 116.4 degrees F. LPA observed facility has the ability to prepare and store food, to lock away cleaning products and other toxins, and lock medications to make inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit and fire extinguishers are maintained and ready for emergency use. Garage area has been reconstructed into a three (3) bedrooms (two resident rooms and one staff room). The Fire Department has re-inspected and has approved renovations to garage space. LPA inspected garage reconstruction which is now equipped for two (2) resident rooms and one (1) staff room. Current facility sketch now matches the facility building layout. Component III was completed with Licensee on Feruary 11,2025. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 3, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Cassandra Mikkelson arrived at the facility and met with Administrator, Vanla Peters, to conduct a Pre- Licensing visit. The facility has a fire clearance for six (6) non-ambulatory residents. Administrator has an active certificate (#7027076740 with expiration date 12/01/2025). LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and one (1) bathroom for resident use. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 116.4 degrees F. LPA observed facility has the ability to prepare and store food, to lock away cleaning products and other toxins, and lock medications to make inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit and fire extinguishers are maintained and ready for emergency use. Component III was completed with Licensee. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 11, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): COMP II Participants: Vanla Peters Interview Method: Telephone interview On January 14, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and 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. Staff/Medications/Training 3. Activities/admission of clients 4. Pre licensing inspection readiness 5. General provisionsthe state’s words, verbatim · CDSS document, Jan 14, 2025