Pristine Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Glenn Trueman conducted the unannounced annual inspection on 7/13/26. LPA met with Staff Vangie Mendoza and explained the purpose of the visit. Shortly thereafter Administrator, Alan Buan arrived. The facility is licensed to serve (6) non-ambulatory residents, ages 60 and over. A hospice waiver has been approved for three residents. There are currently 5 residents residing in the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today. Staff are continuing to follow their Infection Control Plan and using appropriate hand hygiene and wearing gloves when necessary. Staff are adhering to operational requirements. The facility is a single-story home with four resident bedrooms, 1 staff room, 2 bathrooms, an open living room, dining room, and kitchen. The laundry machines are located in the attached garage. The bedrooms are equipped with the necessary furniture and storage space. There are no pools or bodies of water on the premises. Knives and cleaning solutions are locked and inaccessible to clients. The water temperature was measured within the required range of 105-120 degrees F. Sufficient food supplies were observed. LPA reviewed 8 personnel files. The Administrator's certificate expires on 1/8/28. Staff hold current First Aid & CPR certifications and have completed the required annual training hours. LPA reviewed (5) resident files and medications. The files have the required documentation, and staff are administering the medications as prescribed. There are no residents with a restricted or prohibited health condition. The facility is conducting drills at least quarterly. Medication for resident was not administered for AM dosage today 7/13/26. Deficiency was cited on the 809 D. Technical Advisory (TA) was also given regarding tear in window screens. An exit interview was held. A copy of this report and appeal rights were provided to the administrator.the state’s words, verbatim · CDSS document, Jul 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 9/9/25. LPA met with Licensee, Iris Buan and Administrator, Alan Buan, and explained the purpose of the visit. The facility is licensed to serve (6) non-ambulatory residents, ages 60 and over. A hospice waiver has been approved for three residents. There are currently 4 residents residing in the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today. Staff are continuing to follow their Infection Control Plan and using appropriate hand hygiene and wearing gloves when necessary. Staff are adhering to operational requirements. The facility is a single-story home with four resident bedrooms, 1 staff room, 2 bathrooms, an open living room, dining room, and kitchen. The laundry machines are located in the attached garage. The bedrooms are equipped with the necessary furniture and storage space. There are no pools or bodies of water on the premises. Knives and cleaning solutions are locked and inaccessible to clients. The water temperature was measured within the required range of 105-120 degrees F. Sufficient food supplies were observed. LPA reviewed 3 personnel files. The Administrator's certificate expires on 1/9/26. Staff hold current First Aid & CPR certifications and have completed the required annual training hours. LPA reviewed all four (4) resident files and medications. The files have the required documentation, and staff are administering the medications as prescribed. There are no residents with a restricted or prohibited health condition. The facility is conducting drills at least quarterly. There are no deficiencies observed today. An exit interview was held. A copy of this report and appeal rights were provided to the administrator.the state’s words, verbatim · CDSS document, Sep 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with administrator Alan Buan and the purpose of the visit was explained. The following CARE tools domains were utilized during the inspection. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Visitors are no longer screened for COVID-19 or required to sign in. The facility has an Infection Control Plan and COVID-19 Mitigation Plan. Physical Plant/Environment Safety: The facility is a single-story building located in a residential area with four (4) resident bedrooms, one (1) staff bedroom, two (2) resident bathrooms, kitchen, dining area, living room, laundry room, front yard, backyard, and attached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Kitchen drawers containing knives/sharp objects were locked and inaccessible to residents in care. The facility has one (1) fully charged fire extinguisher and a fire pull alarm. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Operational Requirements: The facility has a Dementia Waiver in place. A Hospice Waiver for up to (3) Residents is approved. A fire clearance for 6 non-ambulatory adults 60 and over. Required Liability Insurance is in place. A surety bond is not applicable. Facility does not handle resident's money. Incident Medical and Dental: LPA reviewed medications for five (5) Residents. 30-day supply of resident medications were observed. Centrally Stored Records for medications are kept. Medication stored matches the medication record for each resident. Continued on LIC 809-C Staffing: Sufficient caregiver staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired but currently pending renewal. Personnel files were reviewed. LPA reviewed a total of (5) Staff fIles including the administrator. LPA observed required documents for each. Proof of staff training was reviewed. Current 1st Aid/CPR records are current. Resident Records/Incident Reports: A total of five (5) resident files were reviewed containing admission agreements, Physician's Reports, Appraisals, TB clearance, Functional Capability Assessment, and emergency information forms were observed. Residents Right-Information: RCFE complaint poster and Personal rights were observed and its posted near the entrance. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Modified diets in place. \ Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place and was posted today. There are currently four (4) Dementia residents 60 years and older residing in the facility. Residents with Special Health Needs: One (1) resident receives home health services. Postural support observed. (5) residents with half bed rails. No residents are on hospice. No residents have prohibited health conditions. No residents have restricted health conditions. No deficiencies are being cited on todays visit. Exit Interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 8, 2024