Penny's Guest Home

Type of visit: Required - 1 Year

On 07/23/2026 at 1:00 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival LPA met with Caregiver, Adrian Renz Manalastas and explained the purpose of the visit. Administrator arrived at 2:50pm. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 0 bedroom are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 110.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication were locked and sharps and chemicals were unlocked and accessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased on 03/10/2024. Emergency Disaster plan last reviewed 7/23/2026. Fire Drills conducted 7/15/2026 At 2:00 PM, LPA reviewed 5 of 5 residents records. At 2:50 PM, LPA reviewed 3 staff records and 3 of 3 have first aid training and are associated to the facility. Report Continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed in kitchen unlocked knife drawer, knife on counter top, and unlocked chemicals under sink (Raid, Oven Cleaner) Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 8/1/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 23, 2026

Type of visit: Required - 1 Year

On 07/15/2025 at 2:00 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival LPA met with Caregiver, Adrian Renz Manalastas and explained the purpose of the visit. Administrator was unavailable to attend but approved caregiver to sign report. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 110.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased on 03/10/2024. Emergency Disaster plan last reviewed 7/15/2025. Fire Drills conducted 4/27/2025 At 2:10 PM, LPA reviewed 4 of 4 residents records. At 2:30 PM, LPA reviewed 3 staff records and 3 of 3 have first aid training and are associated to the facility. At 2:40 PM, LPA reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: Required - 1 Year

On 05/30/2024 at 9:50 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival LPA was greeted by caregivers. Licensee arrived at 12:14PM. LPA met with Licensee, Josefina Gardner and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with Josefina including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 69 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms was measured at 111.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased on 01/10/2024. Emergency Disaster plan last reviewed 5/30/2024. At 10:30 AM, LPA reviewed 5 of 5 residents records. At 11:20 AM, LPA reviewed 3 staff records and 3 of 3 have first aid training and are associated to the facility. At 12:00 PM, LPA reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 30, 2024

Allegation investigated: Facility has an infestation of cockroaches

On 1/10/2024 at 12:00 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit to Administrator Josefina Gardner. LPA toured the facility with administrator including but not limited to bedrooms, bathrooms, kitchen, and common areas. During tour LPA did not observeany live cockroaches. During the 10-day complaint visit. LPA interviewed 2 staff. LPA requested copies of the following documents: pest control receipts. Report continues on LIC9099-C Unsubstantiated When LPA spoke with S1 and S2 they stated that they have not seen any cockroaches and regularly have seen the facility get serviced by Orkin Pest Control for bugs. S1 informed LPA that they recall Orkin coming out last year to spray facility. Administrator informed LPA that Orkin maintains the pesticide services to insure facility is bug free No residents were available to interview. LPA did observe bug sprays and one dead dry cockroach trapped behind the glass on the kitchen oven display. 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, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this reportthe state’s words, verbatim · CDSS document, Jan 10, 2024 · control 15-AS-20240102120656

Type of visit: Case Management - Incident

On 1/10/2024 at 11:20 AM (LPA) A. Gomez arrived unannounced to conduct a Case Management in regards to an incident report submitted to CCLD on 1/5/2024. LPA met with administrator Josefina Gardner and explained the purpose of the visit. On 1/5/2024 CCLD received an incident report stating that R1 had passed away on 1/1/2024 in their sleep after being checked on by a caregiver arround 2:30AM. When caregiver retuned at 5:00AM resident was unresponsive. LPA obtained a copy of R1's death certificate that states that resident passed due to Emphysema. R1 also had other conditions such as hypertension and lung disease. LPA also obtained a copy of R1's physicians report. No deficiencies cited during visit. Exit interview conducted with Administrator and a copy of this report providedthe state’s words, verbatim · CDSS document, Jan 10, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) A Gomez conducted an unannounced 1-Year Annual Required visit on this date starting at 1:20pm. Upon arrival, LPA met Administrator, Josefina Gardner. The facility's fire clearance was approved for six non-ambulatory. Administrator holds a current certificate (#6015433740) that expires 04/09/2024. During the visit, LPA toured facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, backyard and common areas. A comfortable room temperature is maintained at 73 degrees F. Hot water temperature measured at 114.7 degrees F. There is a minimum of 2-day perishable and one week perishable foods. Indoor and outdoor passageways were kept free of obstruction. There are no bodies of water observed. LPA observed resident's shared bathrooms were equipped with grab bars and non-skid mat. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last bought on 1/10/2024. Emergency Disaster Plan was last posted on 10/20/2023. Fire drill was last conducted on 4/27/2023. First Aid kit was observed complete. LPA reviewed 3 staff records and 3 of 3 staff are associated to the facility and have current first aid training. LPA reviewed 4 residents records and a sample of residents medications. Report continues on 809C The Following Deficiencies were Observed: During Tour LPA observed unlocked cleaning supplies (comet, windex, Clorox cleaner, ect) under kitchen sink and under bathroom sink. Administrator removed and locked away all chemicals clearing the deficiency. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 1/19/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 10, 2024