Pacific Gardens at Tree Duck

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection and was greeted by administrator (admin) Mary Grace Defeo. Facility is an Adult Residential Care Facility for the Elderly with an approved fire clearance for capacity of 6 (six) residents. There are currently five (5) residents in care with three residents on hospice. LPA toured the building and grounds which was found to be clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were last inspected 5/10/2025. Fire alarm and carbon monoxide alarms all tested and operational. Outdoor furniture accessible for resident use. Water temperature check measured within regulation at faucets accessible to residents within the allowable range of 105 to 120 degrees F. Resident bathrooms observed to have bath mat and grab bar. Disaster drills are being conducted quarterly. All bedrooms were equipped with required furnishing. Facility had an ample supply of linens, towels and extra hygiene products for residents. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Emergency food was not observed to meet the 72 hour emergency supply. LPA advised admin facility must have enough emergency food to meet regulation. Facility kitchen, refrigerators and freezers were clean, and food stored properly. Expiration dates were noted in food items found in refrigerator. Toxins are locked and inaccessible to residents. Sharps and knives were locked. Phone accessible for resident use. LPA conducted a file review for 5 of 5 residents. All documentation and care plans found to be up to date. continued to 809C... continued from 809.... LPA conducted file review for 4 staff, training found to be up to date. LPA verified CPR certificates, which appeared to not be valid in National CPR Foundation website. Certification name, number and date shown in file did not match validation online. 3 out of 4 staff did not have verified or valid CPR certification training (Deficiency Cited, See 809D). LPA and admin conducted a spot check of medication and medication records, all records up to date. Medication is centrally stored and locked. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and report read with Administratorthe state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Post Licensing

At approximately 10:30am, Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a post-licensing visit and was greeted by designee Mary Grace Defeo: Care Coordinator. Post licensing is being conducted after a change of ownership. Facility is an Adult Residential Care For the Elderly with a fire clearance approved for 6 non-ambulatory, 1 can be bedridden in room #4 and a hospice waiver for 5 residents. There are currently 6 residents in care. LPA toured all buildings and grounds and all were found clear from obstruction. Facility was found to be at a comfortable temperature. All required postings were visible. LPA observed there to be an incontinence smell throughout 2 out of 4 rooms. LPA had conversation with admin that keeps must be kept clean and free of odors at all times, (technical violation issued). There was a sufficient supply of nonperishable foods as required by Title 22 Regulations with expiration dates noted. LPA observed there to not be enough perishable food supply for 2 days for 6 residents, (technical violation issued). Toxins were observed to be stored inaccessible to residents. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for all facility sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguisher was observed to be charged and last inspected on 5/04/2025. Smoke and carbon monoxide detectors were tested and operational. Disaster drill last conducted in 4/10/25. LPA had conversation with admin that disaster drills must be conducted quarterly,(technical violation issued). Continued onto 809C.... Continued from 809.... LPA conducted a file review for 3 residents, all files were up to date. Awaiting new admissions agreements for 2 residents under new license. LPA conducted 3 staff file reviews, all files were up to date. Staff due for 20 hour annual training, admin stated staff is already signed up for training. Admin to send copies of 20 hours annual training certificates for all 3 staff once completed by 10/31/25 (advisory issued). Failure to comply may face potential citations from CCL.**** LPA conducted medication spot check with admin and found all medication to be secure with Centrally Stored Log up to date. LPA retrieved the following forms during visit: - Liability Insurance ( exp.11/06/2025) - LIC308: Designation of Responsibility - LIC500: Personnel Report No deficiencies cited during todays visit. Exit interview conducted. Copy of report and LIC9102 (Technical Advisories) discussed and provided to Licensee. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Prelicensing

At approximately 1:30PM Licensing Program Analyst (LPA) Contreras arrived unannounced for a pre-licensing change of ownership visit and met with Residence Care Coordinator and responsibility designee, Mary Grace Defeo. This pre-licensing inspection is for a Residential Facility for the Elderly being conducted for a one story, four bedroom, 2 bath home with a fire clearance approved for capacity of 6 ambulatory and non-ambulatory residents. Currently 6 residents reside at facility. LPA toured the facility with admin and of the indoor and outdoor portions of the facility. Facility was found to be clean and at a comfortable temperature. Facility contained all required postings. Emergency exits clear and free from obstruction. Outdoor area has patio and chairs accessible for resident use. 4 out of 4 bedrooms found in clean and good repair. Two shared rooms. All had required chair, chest drawer and beds were made with appropriate linens. Restrooms had grab bars but no bath mats, admin agreed to provide bath mats for all restrooms. LPA observed emergency food and water supply with 7 day non-perishable foods available. LPA observed no expiration dates on food items. LPA discussed with admin the importance of food expiration dates on all food items under current facility Tree Duck Residential (#486804121). Cleaning products, sharp items, other toxins and chemicals are locked and inaccessible to clients. Extra linens and towels are kept in storage closet. LPA observed fire extinguisher charged and last inspected 5/4/2025. Fire alarm and carbon monoxide alarms were tested and operational. First aid kit available. Water was measured at 106.7 degrees F in faucets used by clients which is within regulation between 105 & 120 degrees F. Signal system on all doors leading out of facility were tested and found operational. continued on 809C... Continued from 809.. LPA reviewed 2 resident records and 2 Staff records, which were all found to be well organized, thorough and contained required documentation. LPA conducted medication spot check and observed all medication to be centrally stored and secure. Medication was found to be pre-poured in locked cabinet and was cited under previous license Tree Duck Residential(#486804121). LPA discussed importance with new admin of not pre-pouring medication. Thick-It Thickener was found to not be centrally stored. Admin removed Thick It Thickener and locked with medication. Component III orientation was conducted at facility with admin. No Deficiencies or Advisories given during visit. Deficiencies given under previous license Tree Duck Residential (#48680412) Pre-Licensing completed. Facility is ready to be Licensed as a Residential Facility for the Elderly. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicants of Status. Copy of report discussed and provided to Applicants. Exit interview conducted.the state’s words, verbatim · CDSS document, May 29, 2025