Orchard Inn

Type of visit: Required - 1 Year

At approximately 8:30 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Licensee/Back up Administrator Keith Fletcher arrived at approximately 9:00 AM. Orchard Inn is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were four (4) residents in care and two (2) staff members on-site. At approximately 8:55 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:05 AM, LPA toured the facility. All exits were clear and unobstructed. The facility's three (3) fire extinguishers were last serviced and tagged in 6/9/2026. The facility was sufficiently lighted. LPA inspected five (5) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 4/19/2026. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 10:05 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed five (5) staff files. Five (5) of five (5) staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Sophie Fletcher’s Administrator Certification 7019221740 is current with an expiration date of 5/19/2027. Keith Fletcher's Administrator Certification 7022153740 is current with an expiration date of 10/4/2026. LPA requested the following documents be submitted to Community Care Licensing by 8/14/2026: LIC 610E Emergency Disaster Plan The facility is in compliance. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to back-up Administrator Fletcher. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 24, 2026

The state marks this report as 5 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

At approximately 1:10 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Caregiver (CG) Aracely Moranaleman. Licensee/Back up Administrator Donald Fletcher arrived at 1:30 PM. Orchard Inn is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were five (5) residents in care and two (2) staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 1:45 PM, LPA toured the facility with Administrator Fletcher. All exits were clear and unobstructed. All three (3) fire extinguishers were last serviced and tagged in 7/2025. The facility was sufficiently lighted. LPA inspected six (6) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 7/29/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 2:25 PM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed four (4) staff files. All staff files were observed to be well organized with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Sophie Fletcher’s Administrator Certification 7019221740 is current with an expiration date of 5/19/2027. LPA requested the following documents be submitted to Community Care Licensing by 10/12/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance The facility is in compliance. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to back-up Administrator Fletcher. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Alviso conducted a required 1-year inspection, approximately 2:10pm on 9/30/2024, and met with caregivers Marilyn Alingcayon,and Miguela Hane. Caregiver Marilyn contacted Licensee/Administrator regarding the LPA's arrival. Administrator Donald (Keith) Fletcher would be coming to the facility to meet with the LPA. Facility has an approved fire clearance for six (6) non-ambulatory residents. Hospice waiver is approved for four (4) residents. Facility has a required infection control plan. Facility has an emergency disaster plan as required. Most recent facility fire/disaster drill was conducted on 5/4/24. The Licensee is to ensure to meet the requirement of holding emergency disaster drills quarterly, and on each shift, ensuring one of the quarterly drills is an evacuation. LPA toured the facility with the Administrator Keith, and caregiver Marilyn; The LPA made the following observations: Facility was at a comfortable temperature and passageways and fire exits were clear of obstructions. Resident rooms were furnished per regulation. Water temperature was measured at 111.1 degrees Fahrenheit, which is within regulation.Sufficient supply of hygiene products, personal protective equipment (PPE), cleaners/disinfectants, paper products, linens, and furnishings. Cabinets containing cleaning/disinfecting supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods; Per staff on shift, main food shopping is done on Fridays. Medications were centrally stored and locked as required. Emergency food and water supplies are stored in the garage; Sufficient supplies to meet the 72-hour shelter in place requirements. All bathrooms had required grab bars for resident use. Facility shower had non-slip flooring/mats for resident use as needed. There was sufficient lighting in all resident rooms, bathrooms, hallways, and common areas. Facility was observed to be clean and orderly. Continued on LIC809C... Fire extinguishers were last serviced July 2024. Smoke and Carbon Monoxide detectors were located throughout the facility as required; All smoke detectors and carbon monoxide detector(s) worked appropriately during the inspection. Four (4) resident files were reviewed. Three (3) staff files were reviewed. All staff have required criminal record clearance. Staff have required First Aid and CPR certificates. Staff have required training. Medications, and medication records were reviewed. LPA is requesting the following documents be updated and submitted by 10/30/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required-if changes submit to CCL-review & sign off on last page.) Infection Control Plan (ensure to review and update as needed/required-if changes submit to CCL-review & sign off on last page.) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate. The following deficiencies were observed during resident file reviews: Per LPA record reviews, R1 & R4 lacked annual medical assessments as required by regulation. This deficiency will be cited, Care of Persons with Dementia 87705 (c)(5)-Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Lead Caregiver, Marilyn Alingcayan. Appeal Rights provided to the caregiver for the Licensee/Administrator.the state’s words, verbatim · CDSS document, Sep 30, 2024