Oaktree Manor

Type of visit: Required - 1 Year

On 09/22/2025 at 8:23am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today's visit was to conduct the one-year inspection. LPA met with Edilberto Bernardino, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 residents from the age range of 60 and over ambulatory, of which 6 may be bedridden with a hospice waiver for 6. (4) of the residents are diagnosed with dementia, (2) residents receive home health, and (2) of the residents are receiving hospice care services. The facility does not handle any of the residents’ money. The facility has a current administrator certificate for Edilberto Bernardino (#708539740) valid from 09/17/2025 - 09/16/2027. The facility fees are current. The facility has liability insurance Kinsale Insurance #0100310726-2 with each occurrence of $1,000,000 and general aggregate of $3,000,000, effective from 07/01/2025 -07/01/2026 The home is a single home consisting of: (6) residents' rooms, (4) bathrooms of one of the bathroom are for visitors, (1) staff room, a living area, a dining area, a kitchen, an outside seating area, a backyard with a garden and an attached garage. Between the hours 12:25pm-12:45pm, LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. The water temperature measured at 117.1°F (in the bathroom #1), 119.8°F (in bathroom #2) and 119.1 °F (bathroom #3). Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards doorways were free of obstructions. Report continues on LIC 809-C Between the hours of 8:45 am - 2:15 pm, LPA conducted a records review of (6) residents records, (5) staff records and (5) Resident Medication Administration Records and the facility disaster plan. The facility disaster plan was current (last conducted on August 2025 at 1:26pm) and in compliance with Title 22 at the time of visit. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did observe deficiencies, and citations were issued at this time. LPA observed the following to be out of compliance with Title 22 regulations: 2 out of 6 resident did not have the LIC 625: Need and Appraisal Plan on file. 2 out 2 residents did not have a Home Health Care of Plan on file 1 out 2 resident did not have a Hospice CARE Plan on file 1 out of 6 staff did not have a LIC 503 Health Screening on file An exit interview was conducted Edilberto Bernardino, Administrator, and a copy of Report and Appeal Rights provided.the state’s words, verbatim · CDSS document, Sep 22, 2025

Allegation investigated: Staff did not meet a resident's incontinence need Staff did not seek timely medical attention for a resident Staff did not properly report an incident involving a resident

On 2/12/2025 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Edilberto Bernardino / Administrator. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#2) and Resident’s interviews (R#1-R#4). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R#1-R#3) Identification and Emergency Information, (R#1-R#3) Admissions agreements, (R#1-R#3) Physicians Report or LIC 602A. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Staff did not meet a resident's incontinence need. The details of the complaint alleged that facility staff is not meeting (R#1)’s incontinence needs. During the records review, LPA Iniguez observed (R#1)’s Physicians Report for the Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated 9/4/2024, it was marked by a physician that (R#1) did not have a bladder or bowel impairment. In addition, (R#1) can follow instructions and communicate their needs. Moreover, LPA Iniguez reviewed (R#1)’s Admission Agreement dated 11/8/24; it was written that (R#1) did not have additional services, such as incontinence services. During an Interview with the Administrator (A#1), he stated that the facility has an incontinence schedule, and the facility staff also changes the residents as needed. Moreover, (A#1) stated that (R#1) did not have incontinence while residing at the facility and never used adult diapers. (R#1) is no longer at the facility, and (W#1) hopes (R#1) is not call regarding this complaint investigation. During interviews with residents (R#2-R#4), (3) out of (3) stated that the facility staff is tending to their needs, including incontinence services. During interviews with facility staff (S#1-S#2), (2) out (2) stated that the facility has an incontinence schedule, and, in addition, the facility staff changes the residents as needed. Also, (2) out of (2) facility staff state that (R#1) did not have incontinence while residing at the facility and never used adult diapers. Evaluation Report continues LIC 9099-C Allegation: Staff did not seek timely medical attention for a resident. The details of the complaint alleged that facility staff did not call 911 when (R#1) felt at the facility. During the records review, LPA Iniguez observed (R#1)’s facility file; LPA did not find incident reports regarding (R#1)’s alleged fall at the facility. In addition, LPA Iniguez reviewed the Regional Office Special Incident Report (SRI) folder, and there are no SRIs regarding the (R#1) incident. During an Interview with the Administrator, (A#1) stated that (R#1) never fell at the facility while they resided there, so there was no need to call emergency services. Also, (A#1) states that the facility staff tends to the residents' needs as much as possible, including (R#1) while they reside there. (R#1) is no longer at the facility, and (W#1) hopes (R#1) are not call regarding this complaint investigation. During interviews with residents (R#2-R#4), (3) out of (3) stated that they feel the facility staff will seek immediate medical attention in case something happens to them. During interviews with facility staff (S#1-S#2), (2) out (2) stated that (R#1) never sustained a fall while living at the facility; if (R#1) had one, they knew they had to call 911. Also, (2) out of (2) facility staff stated that they make sure all resident's needs are met, including (R#1) 's, while they live here. Evaluation Report continues LIC 9099-C Allegation: Staff did not properly report an incident involving a resident. The details of the complaint alleged that facility staff did not report (R#1)’s incident to the appropriated parties (family, doctor, CDSS). During the records review, LPA Iniguez observed (R#1)’s facility file; LPA did not find incident reports regarding (R#1)’s alleged fall at the facility. In addition, LPA Iniguez reviewed the Regional Office Special Incident Report (SRI) folder, and there are no SRIs regarding the (R#1) incident. During an Interview with the Administrator, (A#1) stated that they knew that each incident must be reported to the resident’s family, doctor, and CDSS; however, since (R#1) did not fall while they were living at the facility, there was nothing to report. (R#1) is no longer at the facility, and (W#1) hopes (R#1) are not call regarding this complaint investigation. During interviews with residents (R#2-R#4), (3) out of (3) stated that they think the facility staff will report to their families and doctors in case something happens to them. During interviews with facility staff (S#1-S#2), (2) out (2) stated that since (R#1) did not sustain a fall while living here, there was nothing to report. Also, (2) out of (2) facility staff stated that they know that each incident involving a resident must be reported. Evaluation Report continues LIC 9099-C During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Edilberto Bernardino / Administrator.the state’s words, verbatim · CDSS document, Feb 12, 2025 · control 11-AS-20250207120059

Type of visit: Required - 1 Year

On September 18, 2024, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced required annual visit using the CARE Inspection Tools. LPAs met with Edilberto Bernardino Assistant Administrator and Alvin Ramos House Manager and explained the purpose of this visit. The facility is licensed to operate for (6) ambulatory and (6) bedridden elderly residents ages 60 and above. The facility is approved for (6) hospice residents. There are currently 2 residents in care. Structure: The facility is a single-story structure located in a residential neighborhood. It consists of the following: ( 6) residents' rooms, ( 3 ) bathrooms, (1) staff room, a living area, a dining area, a kitchen, an outside seating area and an attached garage. The construction that was documented in annual visit conducted on 11/30/2023 is in the completed phase. The garage door will be completed by the end of the week per House Manager. Physical Plant LPA and Edilberto Bernardino toured the facility inside and outside. LPA observed There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Page 1 of 4 LPA observed the facility had required postings: ombudsman poster, see something say something poster, emergency numbers, clients rights, employee Federal/State wage information, facility sketch menus, disaster plan. Bedrooms LPA inspected all six (6) bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, night stands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. Resident’s toiletries are secured in a cabinet under the sink. The water temperature measured 111-degrees Fahrenheit. The visitor bathroom was observed to be clean. The toilet and faucets are operational. All bathrooms in the facility were observed to be clean, in good repair and within Title 22 regulations. Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in the hall closets. Page 2 of 4 Kitchen/Laundry Room LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, washer, dryer, refrigerator, and additional freezer. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked drawer in the kitchen and are inaccessible to residents. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. Cleaning products and toxins were secured in hall closet that is inaccessible to clients. Common Rooms In the living room, LPA observed sofa, love seat, 3 recliners, mounted TV and a piano. In the dining room, LPA observed a six seated dinning table and a huge Island area counter with seating for six. Safety LPA observed and tested smoke/carbon monoxide detectors to be fully operable. LPA observed ( 2 ) fully charged fire extinguisher mounted on the wall, last serviced on 10/20/2023. The last emergency drill was conducted on 9/13/2024. LPA inspected the First Aid kit and found it contained an ample supply of required items: Scissors, tweezers, guaze, disinfectant wipes, band aids and a manual. LPA observed all exits to be clear and easily accessible. There are no firearms or ammunition stored on the premises. Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked closet that is inaccessible to Residents in care. Medications observed to be in original packaging with appropriate labels. Page 3 of 4 Files LPA reviewed (2) resident files and found the contained all the necessary documentation. LPA reviewed four (4) staff files and found they contained the required documentation, certification, and training. Liability Insurance expires on 06/30/2025 Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff, and an additional 30-day supply of PPE was observed. Sufficient paper towels, cleaning, and disinfecting supplies were observed. There were no deficiencies cited during today’s visit. An exit interview was conducted with Assistant Administrator Edilberto Bernardino and a copy of this report was provided. Page 4 of 4the state’s words, verbatim · CDSS document, Sep 18, 2024

Type of visit: Required - 1 Year

On 11/30/23, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required using the CARE Inspection Tool. LPA met with house manager Alvin Ramos and explained the purpose of today’s visit. LPA was granted entry to this facility. The facility is licensed to operate for (6) ambulatory and may be (6) bedridden elderly residents ages 60 and above. The facility is approved for (6) hospice residents. During this inspection, LPA observed construction being done in this facility. The construction is blocking emergency exit for bedroom #3. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) residents' rooms, two (2) common bathrooms, (1) staff bedroom which is under construction, a living area, a dining area, a kitchen, and an outside patio area which is not accessible to residents due to construction. LPA toured the physical plant with house manager Alvin Ramos. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. The bathrooms were found to be within Title 22 regulation. Water temperature properly measured between 105F-120F. A comfortable temperature was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers are fully charged, and smoke detectors operable. A working landline telephone remains available. A review of Medication Administration Records and Fire Drill are maintained and in order. The last fire drill was conducted on 09/03/23. Evaluation Report continues LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report on file with CCLD. Deficiencies: During this inspection LPA observed construction being done in facitlity. Licensee did not notify the department of these plans. While reviewing resident files, LPA observed that resident #4 was missing a TB test along with results. Deficiencies are issued and an exit interview was conducted with house manager Alvin Ramos. A copy of this report is provided along with the appeal rights.the state’s words, verbatim · CDSS document, Nov 30, 2023