Nightingale Care Homes

Type of visit: POC

Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management inspection of this licensed senior care facility and was greeted by administrator, Bertrand Mendiola. The purpose of this case management inspection is to follow up on uncleared deficiency cited during annual inspection on 7/14/26. LPA contacted Licensee and administrator on two occasions to follow up on 7/16/26 at 9:24am for POC type A, which the facility submitted proof of corrections after LPA's follow up. On July 29, 2026 at 8:40am, LPA followed up again for type B citation 87303 (a) regarding the facility plan to get rid of ongoing ant issue. As of today's inspection citation 87303 (a) with POC date 7/28/2026 is outstanding. Administrator provided proof of correction for citation 87303 (a). Deficiency cleared from annual inspection 7/14/2026. Copies of documents obtained. No deficiencies cited during today's inspection. Exit interview conducted with administrator and copy of this report was given.the state’s words, verbatim · CDSS document, Jul 31, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived to conduct an unannounced Annual Required inspection and met with Administrator, Bertrand Mendiola. Annual fees are current. LPA/Administrator initiated a tour of the facility and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Extra linens and hygiene products were available. Bathrooms have required grab bars and bath mats. Water temperature in resident bathroom read at 120.9 and 121.1 which is not within acceptable range of 105 to 120 F degrees. Toxins are located in a locked closet in one of the dining room areas. Swimming pool located in the backyard was locked with a padlock and inaccessible to residents in care. Medication is centrally stored in a locked closet near the kitchen. Fire extinguishers were last inspected December, 2025. Smoke alarms and carbon monoxide detector were tested and operational at time of inspection. Auditory alarms were functional at time of inspection. Last disaster drill conducted on 4/01/26. The facility have two days of perishable and one week of non-perishable food available. LPA observed ants during this inspection and administrator confirmed that they have an ongoing issue with ants that they are attempting to mitigate using treatments with vinegar to rid the facility of ants whenever they are observed. Required postings were observed. Administrator will provide copies of the following by 7/28/26: (LIC500) Personnel Report, (LIC308) Designation of administrative responsibility and copy of liability certificate. Continued on LIC809C... Continued from LIC809... LPA initiated file review at approximately 10:00am. Five resident files and three staff files were reviewed. All residents have current medical assessments and care plans updated. At approximate 10:30am, LPA/administrator observed that resident (R1) who is bedridden is occupying room #1, which is not cleared by the Fire Department as a bedridden room. On 4/29/2025, the facility was granted a fire clearance for six non-ambulatory, where room #3 and 6 are cleared for bedridden clients. However, during the physical tour of the facility and records review of residents in care, it was observed R1 is occupying room #1. Licensee is operating outside the limitation of the license by accepting a bedridden resident in a non-ambulatory room. LPA/administrator had a conversation about the issue with R1 and provide the option to relocate resident to a bedroom cleared by the fire marshal for bedridden residents, but according to the administrator and LPA's observation, R1 is not bedridden, so administrator will reach out to R1's physician to obtain an updated physician's report (LIC602). During the visit, LPA spoke with R1 who expressed that they are not fully bedridden and they are in agreement to obtain an updated medical assessment. All staff have active CPR and First Aid certificates and training hours required. Administrator Certificate for Bertrand Mendiola, 6080052740 expires 12/7/27. Medication and medication records were reviewed. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Administrator and a copy of this report will be emailed due to LPA is having printer issues.the state’s words, verbatim · CDSS document, Jul 14, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cuadra arrived unannounced for the purpose of reviewing the personnel report (LIC500) due to a change of administrator and met with Bertrand Mendiola, back up administrator. During today's visit, LPA confirmed that designated administrator is associated to the facility. Per Personnel Report (LIC500) indicates administrator's schedule listed for two days per week and back up administrator is listed as working 40 hours per week. Previously, LPA raised concerns during pre-licensing visit on 12/15/2022 due to Licensee was going to be listed as the administrator, but their residency is a distance away from the facility and it was determined in written plan submitted at that time that Licensee agreed to spends a reasonable amount of time in the facility, resident's care needs will be met in case of an emergency and Community Care Licensing inspections. Based on records review, back up administrator's certification is still pending under the department's review list, but it was confirmed that their schedule is within compliance with regulation. However, LPA had a conversation with them to ensure previous plan agreed was still been followed. No deficiencies noted at the time of this visit. Exit interview conducted with back up administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived to conduct an unannounced Annual Required inspection and met with Administrator, Kasandra Guerrero. Annual fees are current. Contact information reviewed. Residents were engaged in activities when LPA arrived at the facility. LPA/Administrator initiated a tour of the facility at approximately 9:00am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Extra linens and hygiene products were available. Bathrooms have required grab bars and bath mats. Water temperature in resident bathroom read at 122.4, 129.7 and 127.8 which is not within acceptable range of 105F and 120F. Toxins are located in a locked closet in one of the dining room areas. Swimming pool located in the backyard was locked with a padlock and inaccessible to residents in care. Medication is centrally stored in a locked closet near the kitchen. Fire extinguishers were last inspected December, 2024. Smoke alarms and carbon monoxide detector were tested and operational at time of inspection. Auditory alarms were functional at time of inspection. Last disaster drill conducted on 3/25/25. The facility have two days of perishable and one week of non-perishable food available. Required postings were observed. LPA initiated file review at approximately 9:30am. Five resident files and three staff files were reviewed. Staff have active CPR and First Aid certificates and training hours required. Five residents have current care plans and medical assessments. Continue on LIC809C... Continued from LIC809... Administrator Certificate for Kasandra Guerrero, 6067815740 expires 9/25/25. Medication and medication records were reviewed. During file review, LPA/Administrator observed cameras located in three locations in the common areas. LPA/Administrator previously discussed during post-licensing to notify resident's responsible parties through their admission agreement the use of video surveillance without audio. LPA/Licensee discussed Dementia regulation changes and confirmed that they have reviewed updated regulations including physician's report (LIC602A). Administrator will provide copies of the following by 7/1/25: (LIC500) Personnel Report, (LIC308) Designation of administrative responsibility, copy of liability certificate and control of property. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Jun 17, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a case management visit and met with Administrator, Kasandra Guerrero. The purpose of this case management visit is to follow up on two self-incident reports submitted to the Department notifying about resident's (R1) hospitalization. According to incident report dated 4/21/25, on 4/18/25 at approximate 9am, Administrator observed R1 having hard time breathing, Administrator called the paramedics who transported R1 to the hospital for further evaluation and responsible parties were notified. R1 returned to the facility on 4/20/25 with no new medications. Per second incident report dated 4/24/25, on 4/22/25, staff on duty observed R1 who appeared weak and stated that they were having difficulty breathing; Oxygen saturation taken was low at 88%, then paramedics were called again and transferred R1 to the hospital again for further evaluation. According to Administrator, R1 was transferred to skilled nursing for treatment. During today's visit, LPA also followed up on recent fire clearance update request submitted by the facility on 4/7/25 along with required documentation including Application indicating additional room without structure construction (LIC200), facility updated sketch, Emergency Disaster Plan (LIC610E), control of property, Personnel Report (LIC500), addendums to plan of operation addressing safety issues, activities, food service or any area of the facility operation that might be impacted by change of rooms. LPA toured the new room and observed a large area with required furniture items as follow: a portable closet, lamp, three drawer night stand, recliner and bed with adequate supplied with a mattress, good springs, pillow and bedding linens. According to Administrator, the fire department is expected to come today and inspect the room for further approval. LPA have confirmed with Administrator understanding that they will need updated fire clearance approval prior to admit a new resident to the facility. Exit interview was conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Apr 29, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cuadra and support staff Ethel Contreras arrived unannounced to conduct a case management visit and met with Administrator, Cassie Guerero. On 12/6/24 the administrator have contacted the Department requesting guidance regarding a possible increase of capacity from six to seven residents. During today's visit, LPA/Administrator have discussed about the possibility of increasing capacity and after the conversation, the administrator acknowledged that in case that they wanted to proceed with the change of capacity process they will submit required documentation to CCL. Also, LPA/Administrator had a discussion about the facility temperature after noticing that there were some rooms where the temperature was warmer than others. The temperature observed was set at 74 degrees. Per Administrator, they are working with a contractor who will come to inspect the facility to ensure that insulation is adequate for all rooms. Also, LPA reviewed current LIC500 Personnel Report and had a conversation with Administrator regarding possible staff (S1) who are not able to fully speak English could not be left alone working providing care and supervision to residents in care. Per Administrator, there is one staff (S1) who works that have some challenges speaking the language, but they are not left alone with the residents. LPA explained to the Administrator that the licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services (technical advisory was issued). Exit interview was conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Dec 9, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived to conduct an unannounced Annual Required inspection and met with Administrator, Kasandra Guerrero. Annual fees are current. Contact information reviewed. LPA/Administrator initiated a tour of the facility at approximately 9:15am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Extra linens and hygiene products were available. Bathrooms have required grab bars and bath mats. Water temperature in resident bathroom read at 111.7 and 111.7 F which is within acceptable range of 105F and 120F. Toxins are located in a locked closet in one of the dining room areas. Swimming pool located in the backyard was locked with a padlock and inaccessible to residents in care. Medication is centrally stored in a locked closet near the kitchen. Fire extinguishers were last inspected December, 2023. Smoke alarms and carbon monoxide detector were tested and operational at time of inspection. Auditory alarms were functional at time of inspection. Last disaster drill conducted on 7/13/24. The facility have two days of perishable and one week of non-perishable food available. However, LPA/Administrator discussed the benefits of having an ample supply of food. Per Administrator, today is shopping day and they were heading to the store when LPA arrived. Required postings were observed. LPA initiated file review at approximately 10:00am. Five resident files and three staff files were reviewed. Staff have active CPR and First Aid certificates and training hours required. One out of three staff LIC503 did not include TB test results (technical violation issued). Five residents have current care plans and medical assessments. Administrator Certificate for Kasandra Guerrero, 6067815740 expires 9/25/25. Medication and medication records were reviewed. During LPA's visit, residents were observed engaged in music activities. Administrator provided copies of the following: (LIC500) Personnel Report, (LIC308) Designation of administrative responsibility, copy of liability certificate and control of property. No deficiencies cited during this inspection. Exit interview was conducted with Administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 29, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management Inspection and met with Kasandra Guerrero, Administrator. During today's visit LPA is following up on four incident reports received at CCL on 3/11/24. The first incident report was reported to CCL on 2/26/24 via email. Per incident report, on 2/26/24 at approximate 12:30pm resident (R1) was observed coughing and being slight short of breath, staff contacted R1's physician who advised them to bring R1 to the emergency room for further evaluation. Responsible parties were notified including CCL. R1 was discharged on 2/28/24. Per interviews conducted with staff, LPA was told that the facility conducted testing for Covid-19 to all residents, but the results were negative. Based on discharge documents, R1 was treated for acute on chronic hypoxemic respiratory failure due to another COPD exacerbation and had a follow up appointment with their physician to discuss further treatment. Second incident report was reported on 2/26/24 via email. Per incident report, on 2/26/24 resident (R2) was also observed having shortness of breath and coughing a lot, R2's physician also advise the staff to transport R2 to the emergency room for further evaluation. Responsible parties were notified including CCL. R2 was discharged on 3/3/24. Based on records review provided to LPA during the visit, R2's discharge documents indicates that they were treated for respiratory failure, recurrent pleural effusion, possible pneumonia and acute kidney injury with some medications were discontinued and others were adjusted. R3 had a follow up appointment on March 8, 2024 to discuss further treatment. Continue on LIC809C... Continued from LIC809... Last two incident reports were regarding resident (R3), reports were submitted via email to CCL on 2/24/24 and 2/26/24 respectively. Per incident reports, on 2/23/24 at approximate 5pm, R3 was observed very confused, lethargic, staff contacted R3's physician and were advised to transport R3 to the hospital for further evaluation. Responsible parties were notified including CCL. On 2/24/24 R3 was discharged from the hospital and passed away on 3/4/24 at 4:29pm. During today's visit, LPA was provided with R3's discharge documents stating that R3 has a diagnosis of dementia, R3 was treated for severe sepsis with acute organ disfunction, and they were admitted to receive hospice services and they passed away on 3/4/24. No deficiencies were issued during today's visit. Exit interview conducted with Administrator and copy of the report was given.the state’s words, verbatim · CDSS document, Mar 28, 2024

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Cuadra conducted the Post Licensing inspection and met with lead staff Cassie Guerrero designated substitute on file. Licensee/Administrator was not able to come to the facility due to their residency is a distance away from the facility, which it was previously discussed with Licensee during pre-licensing visit conducted on 12/15/22. LPA have a discussion via phone with Licensee and was informed their intentions are to appoint an Administrator that will ensure to spend a reasonable amount of time in the facility, resident's care needs will be met in case of an emergency and Community Care Licensing inspections. Documents needed to appoint a new Administrator are as follow: (LIC 500) Personnel Report, LIC308 Designation of Facility Responsibility, LIC215 Applicant Information, LIC501 CCL/Personnel Record and detailed employment/education history. Facility has a Dementia Care Plan approved to care for residents with dementia care needs. No residents in hospice. Facility is a single story residence and has 5 bedrooms for residents in care. The fire clearance for six non-ambulatory residents was granted 11/1/2022 by Sonoma County Fire Department. Fire extinguisher was last serviced 12/13/2022. The facility have not conducted a fire drill for the last quarter. LPA/Staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Smoke alarms and carbon monoxide detector were tested and operational at time of inspection. Auditory alarms were functional at time of inspection. Water temperature in bathroom used by residents measured 127.6 degrees F which is not within the range of 105 to 120 degrees F allowed per regulation. Required postings observed. Continued on LIC809C... Continues from LIC809... Extra hygiene products and linens were available. Cleaning supplies are stored in the locked laundry room. Facility has at least two days of perishable and one week of non-perishable foods. Facility has emergency food and water supplies. Bathrooms had required bath mats and grab bars. LPA/lead staff observed cameras located in three locations in the common areas. Per lead staff, the cameras are not working at this moment, but they have not decided if they are going to proceed to install their own cameras or not. Licensee agreed to notify CCL of any updates and is aware that if they decide to install them, the facility plan of operation and admission agreement informing family of video surveillance will need to be submitted to CCL for review. Medications and medication records were reviewed. At approximate 10am LPA initiated resident and staff records reviewed. Five out of five staff has an active First Aid/CPR Certificate and staff's annual required training hours. All residents have a current medical assessment on file. One out of five resident's (R1) care plan needs to be updated. Licensee has not completed new Admission Agreements for 4 out of 5 residents. Medications is centrally stored and locked in a cabinet located in the hallway and inaccessible to clients. Facility agrees to submit updates of the following by 11/30/23: -LIC 500 Personnel Report -LIC308 Designation of Facility Responsibility. -Copy of Liability Insurance -Control of Property. -LIC 610 Emergency Disaster Plan (If changes) -Infection Control Plan (If changes) Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Lead Staff, Licensee was made aware of citations via phone and a copy of this report was given.the state’s words, verbatim · CDSS document, Nov 2, 2023