Peninsula Elderly Care Home - Laurelwood

Type of visit: Case Management - Annual Continuation

On 2/27/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to complete the Annual 1-year required inspection. LPA Calandra was greeted by Arlene Johnson, Caregiver and explained the purpose of the visit. Jennifer Tobias, Administrator arrived later during the visit. LPA toured the physical plant. This is a 1-story building with 6 bedrooms, 7 bathrooms including a shower room, dining room, kitchen, living room, front and backyards. The facility was maintained at a comfortable temperature. All bedrooms had the required furniture and sufficient lighting. All bathrooms had anti-skid flooring and grab bars. The facility's fire and carbon monoxide detectors were observed to be working. The facility's fire extinguishers were observed to be fully charged and last serviced on November 13, 2025. The facility had the required 7 days of non perishables and 2 days of perishables. No food was expired. The facility's first aid kit had the required items. All soap, detergent, poisons, and sharp objects were observed to be locked and in-accessible to persons in care. A review of Centrally Stored Medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted and a copy of the report provided to facility representative.the state’s words, verbatim · CDSS document, Feb 27, 2026

Type of visit: Required - 1 Year

On 2/20/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Arlene Johnson, Caregiver and explained the purpose of the visit. Jennifer Tobias, Administrator arrived later during the visit. LPA reviewed 6 staff records and 5 resident records as well as training records. All were observed to be complete. No deficiencies cited during today's visit. During the visit, LPA collected the following documents: LIC 500, Liability Insurance, LIC 610D This Annual will be completed at a later date. An exit interview was conducted. A copy of the report along with Appeal Rights were provided to the facility representative.the state’s words, verbatim · CDSS document, Feb 20, 2026

Type of visit: Case Management - Annual Continuation

On 2/7/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to continue the Annual 1-year required inspection started on 1/9/2025. LPA Calandra was greeted by Jennifer Tobias, Administrator and explained the purpose of the visit. All sharp objects, poisons, and detergents were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident records and 5 staff files. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA Calandra received a copy of the Facility's Dementia Care Plan. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left the facility.the state’s words, verbatim · CDSS document, Feb 7, 2025

Type of visit: Required - 1 Year

On 1/9/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 2:31 PM to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Arlene Jonson, Caregiver and explained the purpose of the visit. LPA toured the physical plant. This is a 1-story building with 6 bedrooms (5 bedrooms for residents and 1 for staff, 7 bathrooms, a dining room, living room, kitchen, and backyard. Hot water temperature was measured within the required 105-120 degrees Fahrenheit. All bedrooms had the required furniture and sufficient lighting. The facility was maintained at a comfortable temperature. The facility had the required 7 days of non perishables and 2 days of perishables on hand. No food was expired. The Annual will be completed at a later date. Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report along with Appeal rights left at the facility.the state’s words, verbatim · CDSS document, Jan 9, 2025

Type of visit: Required - 1 Year

On February 20, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Assistant Administrator, Jennifer Tobias and explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageways were free of obstruction. No accessible bodies of water of fire safety hazards observed. LPA observed six private resident rooms, all of which have half-baths. Rooms were observed clean, in good repair with all required furniture. Half-baths observed were clean and odor-free. LPA observed two full bathrooms; equipped with liquid soap, paper towels, and non-skid mats. Extra linen and first aid kit was present. Living room and dining room was toured, no tripping hazards were observed. A comfortable temperature is maintained and lighting is sufficient for comfort. LPA toured kitchen and observed two day perishable and seven day non-perishables. According to the Assistant Administrator, the water heater stopped working at 10:30am this morning and the facility currently does not have any hot water. During the visit, LPA observed third-party contractor working on repairing the water heater. Heating and A/C unit was observed working. Licensee faxed CCL an incident report immediately. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of November 2023. Emergency drills are logged and done every three months. Extra linen and first aid kit was observed present. Toxins, sharps, and medication were locked and inaccessible to residents in care. LPA reviewed 5 resident records and 5 staff records. Staff records are complete, with training logs that have met the basic requirement. 2/5 resident files reviewed did not have did not have pre-admission appraisals in resident file. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in additional civil penalties. Report is reviewed with Assistant administrator and a copy is provided with appeal rights.the state’s words, verbatim · CDSS document, Feb 20, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On December 8, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit to follow up on a total dependent care exception request from the facility for resident #1 (R1). LPA met with Assistant Administrator, Jennifer Tobias and explained the purpose of the visit. During the visit, LPA observed R1, obtained training records, and interviewed the administrator. Based on observations, R1 was observed sitting on a chair in his/her bedroom. R1 is able to communicate very little, however according to assistant administrator, R1 is able to tell staff if he/she needs anything. According to the assistant administrator and staff interviewed, R1 is two persons assist. Staff use a hoyer-lift to transfer R1. Staff interviewed indicated, R1 is able to hold utensils and glasses, however R1 can't bring it up to his/her mouth. Assistant administrator indicated that R1 is unable to conduct one ADL on his/her own and a staff will always have to assist. R1 is able to help staff repositioning himself/herself. LPA requested copies of staff training for hoyer-lifts, however assistant administrator was unable to provide copies. According to the administrator, the facility provides training for postural support and staff are trained for hoyer-lifts, however there was no documentation provided to LPA to show staff are trained to use hoyer-lifts. Deficient is cited under California Health and Safety Code on the LIC809D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with the Assistant Administrator and a copy is provided via email.the state’s words, verbatim · CDSS document, Dec 8, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Dec 15, 2023

87412 Personnel Records: (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. Violation of this regulation is not met as evidenced by: Staff use a hoyer-lift to transfer R1. Licensee failed to provide LPA staff training documentation to show staff are trained to use a hoyer-lift.the state’s words, verbatim · CDSS document, Dec 8, 2023

Plan of correction: Licensee/Administrator to conduct an in-service training with staff on how to properly operate a hoyer-lift by 12/15/2023.