Perpetual Manor

Type of visit: Case Management - Annual Continuation

Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 09/01/26. LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak with Licensee/Administrator. Staff phoned Angelica Fernandez and she arrived shortly after. The two toured the facility. The inspection began in the kitchen. All knives and sharps were in drawers with locks and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. There were 2 fire extinguishers, both were last serviced on 04/22/26 by Sacramento Fire Extinguisher Co. and were in compliance at the time of this inspection. LPA inspected the 6 resident bedrooms, dining/activity room, kitchen/dining area, living room, the laundry room, and garage where the Administrator kept their office. All resident rooms had the required furniture, furnishings and lighting to be in compliance at this time. LPA inspected the resident bathrooms and noted trash cans with lids, grab bars in the bathrooms, and non-skid surfaces in the shower units. The exterior of the building was inspected by the LPA. The yard was completely fenced in and had a paved walkway for residents to ambulate. There were two shaded areas with furniture for residents to enjoy. The LPA observed medications were stored in a locked medication cart and inaccessible to residents in care. LPA reviewed the Centrally Stored Medication Log, the Medication Administration Record, and reviewed destruction and PRN procedures with the Administrator. A review of the First Aid kit by the LPA found it to be complete and in compliance. LPA compared Guardian Roster to the LIC 500 to ensure that all staff were appropriately background cleared as required. All were in compliance a the time of this inspection. A file review was completed by the LPA. LPA reviewed 2 staff files and 2 resident files. All were in compliance at the time of this inspection. LPA provided technical assistance regarding the exact numbers of training required for required topics. According to the California Code of Regulations, Title 22, no deficiencies were cited during today's visit. A copy of this report was provided and an exit interview was conducted with Fernandez.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Required - 1 Year

On 7/23/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their annual inspection visit. LPA met with Administrator Angelica Fernandez (S1), and stated the purpose of the visit. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents. All 6 bedrooms were approved for non-ambulatory use. Facility does not have bedridden clearance at this time. Facility has approved hospice waiver for 3 residents. Initial Observation: Present during this visit were 5 residents in care with 3 staff on duty (S1, S2, S3). LPA was greeted by one of the staff on duty (S2) and one resident in care. LPA observed required posters and facility license at the entrance. Room temperature was at 73 degrees Fahrenheit upon arrival. Another staff on duty (S3) was observed to be preparing food for residents. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 4 of 5 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout. Each bedroom is equipped with smoke detectors. Bedroom #5 is currently vacant. LPA measured the hot water temperature in the 1 of 3 bathrooms to be at 108.5 degrees Fahrenheit. Resident bathrooms were observed to be in clean and good repair at this time. There is a fire door leading to bedrooms #1-3. The fire door was observed to be closed during this visit. Bedrooms #1 and #2 have shared bathrooms. {Con't to 809-C} {Con't from 809} Fire extinguisher was observed in the kitchen area and was last inspected on 5/5/2025. Smoke and carbon monoxide detectors were observed throughout. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. In the kitchen area, LPA observed sufficient seven day non-perishable and two day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Proper storage of food items were observed. Kitchen refrigerator and freezer were maintained at regulatory temperature. Outdoor area was inspected. LPA observed outdoor furniture for resident use. Ramps were observed to be in good repair at this time. Emergency walkways were observed to be unobstructed. Two decorative fountains were observed. Per licensee, staff ensure residents are supervised when near these fountains. Record Reviews: Review of 3 of 3 resident files (R1, R2, R3) was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. No issues were noted at this time. Medication review of 2 residents (R1, R2) include review of physician orders for over-the-counter medications. No issues were noted at this time. Review of 3 staff files (S1, S2, S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. LPA also reviewed fire drill/disaster drill records; facility conducts monthly drill. Last drill was conducted on 7/1/25. LPA also reviewed first aid kit and found to be complete at this time. LPA was provided a copy of current Liability Insurance Certificate, LIC500 and LIC308 during this visit. Interviews: LPA interviewed 1 staff on duty and 1 resident in care during this visit. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were cited. Exit interview was conducted with S1. A copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Jul 23, 2025

The state marks this report as 6 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

On 7/12/24, at 9:45am, Licensing Program Analyst (LPA) Arvin Villanueva arrived to the facility unannounced to conduct a required annual visit. LPA met with Administrator Angelica Fernandez (ADM), and stated the purpose of the visit. LPA and ADM toured the facility to ensure compliance of Title 22 regulations. The facility is a single story home located in a residential neighborhood. LPA observed resident bedrooms, bathrooms, common areas, kitchen, dinning room, and exterior areas. Resident bedrooms were observed to be clean and spacious enough to accommodate residents' belongings. The two bathrooms were observed to be clean and equipped with grab bars and non-skit flooring. Common areas were furnished, clean and free of obstruction. LPA observed the temperature inside the facility was measured at 72*F. The hot water was measured at 107*F. Facility maintains nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area, sharps, and chemicals to be locked and inaccessible to residents in care. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. Smoke detectors and carbon monoxide were tested and observed to be operable during this visit. Residents were observed watching television, eating lunch, and inside of their room. LPA also observed two new staff being trained by staff on duty. LPA reviewed 5 staff files and 6 resident files. Technical assistance was provided to annually update medical assessments for dementia residents. All staff files reviewed had necessary training and completed files. Medication review was conducted with 2 of 6 residents and no issues were noted. Emergency drills were conducted and up to date. LPA requested current Liability Insurance, LIC500 and LIC308. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, and copy of report was provided.the state’s words, verbatim · CDSS document, Jul 12, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.