Redwood Vista Residential Care Home

Type of visit: Required - 1 Year

At approximately 8:40 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Administrator Angelica Martinez arrived at 9:05 AM. Redwood Vista Residential Care Home is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents, one (1) of whom may be bedridden. The facility has a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were five (5) residents in care and two (2) staff members on-site. At approximately 9:05 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:15 AM, LPA toured the facility with Administrator Martinez. All exits were clear and unobstructed. The facility's one (1) fire extinguisher was last serviced and tagged in 10/7/2025. The facility was sufficiently lighted. LPA inspected five (5) residents bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills every six months. Regulations state that emergency disaster drills be held quarterly. The facility drill log is showing the last disaster drill having been held on 12/16/2024. The administrator stated that the last disaster drill was held yesterday, 12/1/2025; however, the drill log for this drill is not at the facility. This deficiency will be cited. As this is the second (2) time the facility has been cited for this deficiency in under a year, a Civil Penalty of $250 is being issued. Continued on 809-C... ...Continued from 809 The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. At approximately 10:00 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed with all required documentation. LPA reviewed four (4) staff files. One (1) of four (4) staff files (for staff member S1) was observed not to have current first aid certification. This deficiency will be cited. Four (4) of five (5) staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Angelica Martinez’s Administrator Certification 496803740 is current with an expiration date of 4/11/2027. LPA requested the following documents be submitted to Community Care Licensing by 1/2/2026: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance Updated Facility Lease or deed Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, 811 Confidential Names, LIC 421FC and Appeal Rights discussed and provided to Administrator Martinez. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 2, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 12/10/24 at approximately 10:00am, and met with Licensee/Administrator Angelica Martinez. Fire clearance is approved for six (6) non-ambulatory, of which one (1) may be bedridden. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. LPA toured the facility with the Administrator. Hot water was checked at 116. degrees Fahrenheit, which is within regulation. The food supply was sufficient in perishable and non-perishable items. The facility had a sufficient supply of linens, furnishings, paper products, hygiene items, cleaners/disinfectants, and personal protective equipment (PPE) for use by the facility. The exits were free and clear from obstruction. All medications were locked and inaccessible to residents in care. All cleaners/disinfectants were locked and inaccessible to residents in care. Facility has two (2) fire extinguishers that were serviced and tagged as required. The facility had all required smoke alarms, all working appropriately. Facility carbon monoxide detector was working appropriately. All exits had auditory alarms. There are currently five (5) residents in care; Four (4) of the residents were at day program during the inspection. LPA reviewed five resident files, including medication records. LPA reviewed four staff files, including training. All staff have criminal record clearance as required. All staff have first aid and cpr certification as required. Continued on LIC809C... LPA is requesting the following documents be updated and submitted by 1/10/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review, update as needed/required- submit copy) Infection Control Plan- (ensure to review, update as needed/required- submit copy) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate The following deficiencies were observed during the inspection: Per review of records, there was no documentation showing proof of having conducted required emergency disaster quarterly drills; Administrator was not able to show proof of quarterly drills having been conducted. This deficiency will be cited, HSC 1569.695(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, see LIC809D. Per record reviews, S1, S2, and S4 lacked CPR certification, and S3 lacked first aid and CPR certifications. Administrator was not able to show proof of staff having the training specified above for each staff. This deficiency will be cited, HSC 1569.618(c)(3) Other Provisions Section – Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and staff have first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Licensee/Administrator Angelica Martinez. Appeal rights given to the Administrator.the state’s words, verbatim · CDSS document, Dec 10, 2024

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required - 1 yr. visit of the facility. LPA was welcomed by staff Laura Lopez Monroy. Angelica Martinez - Licensee was contacted by staff and arrived during the visit. There were two caregivers providing care and supervision for 3 residents. Three residents were at day program. There is no residents currently with a diagnostic of dementia, as well no residents on Hospice or using oxygen. LPA initiated a tour of the facility at 9:00 AM on 11/16/2023 and made the following observations: Facility was found to be clean and at a comfortable temperature with all passageways and exits free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathrooms measured at 118.5 degrees F and 119.1 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathrooms while touring facility on 11/16/2023. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cabinet in garage containing cleaning supplies and toxins was unlocked along with cabinet underneath kitchen sink containing cleaning supplies, Regulation 87309(a)(see LIC809-D). Bathroom contained cloth towels and no paper towels for clients use, Regulation 87307(3)(c)(TV see LIC9102). Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored in kitchen cabinet although unlocked, Regulation 87465(h)(2) (see LIC809-D). Fire extinguisher was last inspected 9/15/2023. Smoke detectors and Carbon Monoxide detectors located throughout facility were tested and operational. All six exit doors have auditory alerts that were functional at time of visit. Continued on LIC809C Continued from LIC809 A review of 6 resident & 6 staff records as well as two resident’s medications was conducted during this visit. LPA reviewed resident’s files at 10:45 AM on 11/16/2023 and learned that 6 of 6 residents have an updated re-appraisals/needs & care plans, IPP's and updated physician’s assessments (LIC 602A) on file. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 11/16/2023 at 1:30 PM; although facility is pre-pouring medications (see pics) in kitchen and outside office, Regulation 87465(h)(5) (see LIC 809D) Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be incomplete and inaccurate per regulations (see TV LIC9102) LPA reviewed a sample of staff records and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff files have proof of annual training requirements for 2023 on file. LPA was presented with proof of CPR for required staff although none of the six staff had required 1st Aid certification in files that were reviewed, Regulation 87411(c )(1) (see LIC 809-D). Administrator Certificate for Angelica Martinez 6001706740 expires 4/10/2025. LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; ensure that disaster drills are conducted in different shifts, and review facility emergency plan to ensure accuracy according to the needs of facility residents. Administrator informed Disaster Drills are conducted every six months although regulations is quarterly with the last disaster drill being conducted on 1/18/2022, over a year ago out of Title 22 regulations HSC 1569.696(c). Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Continue on LIC809-C LPA Hansen is requesting facility to submit the following documents to CCL by 12/05/2023: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Current Administrators Certificate Copy of Control of Property Deed Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Nov 16, 2023

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.