Rock of Ages Manor Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced, Required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit to the Administrator Maryl Evangelista. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, ages sixty (60) and over. The facility is also approved for one (1) bedridden resident that may reside in bedroom #2. Hospice waiver granted for six (6). LPA and Administrator toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to residents were all compliant. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives and sharps were locked and inaccessible to residents. (Continued on LIC 809-C) (Continued from LIC 809) No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed multiple staff and resident records. The reviewed records contained required documents. Confidential records were stored in locked areas. Licensee also presented proof of current/active business liability insurance. No deficiencies were observed or cited. An exit interview was conducted with Administrator Maryl Evangelista to whom a copy of this report was provided. Their signature below confirms receipt of this document.the state’s words, verbatim · CDSS document, Apr 30, 2026

Allegation investigated: Staff are not mitigating the spread of infectious outbreaks in the facility. Staff are not providing residents with adequate hand-washing supplies

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the findings in the above-mentioned complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Administrator Maryl Evangelista Administrator . During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents, and outside sources. On July 31, 2025, the department received a complaint alleging that the facility staff are not mitigating the spread of infectious outbreaks in the facility and that staff are not providing residents with adequate hand washing supplies. (Continued on LIC9099C) Unsubstantiated (Continued from LIC9099 2 of 3) Interviews were conducted with three (3) residents. Residents reported that they feel safe and that staff are proactive in preventing the spread of infections. Resident 1 (R1), mentioned, "The staff always reminds us to wash our hands and provides us with hand sanitizer." Interviews were conducted with three (3) outside sources. Family members confirmed that they have observed staff following proper infection control procedures and providing adequate hand washing supplies. Interviews were conducted with two (2) staff members. Staff members confirmed that infection control measures, such as regular hand washing, use of personal protective equipment (PPE), and isolation protocols, are consistently followed. One Staff 1 (S1), stated, "We are very diligent about following infection control protocols to keep everyone safe." Interviews were conducted with staff members, residents, and outside sources. All interviewees confirmed that infection control measures, such as regular hand washing, use of personal protective equipment (PPE), and isolation protocols, are consistently followed. During the visit, multiple areas of the facility were observed. Staff were seen adhering to infection control protocols, practicing hand hygiene, and following isolation procedures for affected individuals. Hand washing stations throughout the facility were observed to be adequately stocked with soap, paper towels, and hand sanitizer. Staff were observed replenishing supplies as needed. A review of infection control logs, training records, and appropriate measures to mitigate the spread of infectious outbreaks. No significant lapses were identified. The facility's policies on infection control and hand hygiene were reviewed and found to be comprehensive and in compliance with Title 22 and California Health and Safety regulations. Previous compliance audits and inspections showed no issues related to infection control practices or the provision of hand washing supplies. Continued from LIC9099 3 of 3) It was alleged that staff not providing adequate hand washing supplies. Interviews were conducted with two staff members, three (3) residents, and two (2) outside sources. All interviewees confirmed that hand washing supplies (soap, paper towels, hand sanitizer) are consistently available in all necessary areas. During the visit, multiple hand washing stations were observed. All stations were adequately stocked with soap, paper towels, and hand sanitizer. A review of supply orders and inventory records for the past 6 months showed regular and sufficient ordering of hand washing supplies. No discrepancies were found. The facility's hand hygiene policy was reviewed and found to be comprehensive and up-to-date. Previous compliance audits showed no issues related to hand washing supplies. This Department has investigated the above complaint allegations. The Department has found that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report and licensee rights (LIC 9058 03/22). Administrator's signature on this form confirms receipt of these rights.the state’s words, verbatim · CDSS document, Aug 27, 2025 · control 08-AS-20250731101333

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced, Required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified herslef to, and discussed the purpose of the visit to Maryl Evangelista, Administrator. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, ages sixty (60) and over. The facility is also approved for one (1) bedridden resident that may reside in bedroom #2. Hospice waiver granted for six (6). During today’s inspection there were five (5) residents in care. LPA and Administrator toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives and sharps were locked and inaccessible to residents. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee also presented proof of current/active business liability insurance. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Maryl Evangelista to whom a copy of this report was provided. Their signature below confirms receipt of this document.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Amy Rodgers conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to the applicant’s representative, Administrator Maryl Evangelista. The facility fire clearance was granted on 2/7/2024 and reflected that the facility was approved for six (6) residents in total, of which all may be non-ambulatory and one (1) may be bedridden in room 2 only.Hospice Waiver granted for six (6)The facility's fire clearance did not include delayed-egress door or secured perimeter endorsements, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPA, accompanied by the applicant’s representative, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was compliant at 73 degrees F. Hot water temperature at taps accessible to residents were also compliant. The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order. Refrigerator temperature was 38 F, and freezer temperature was 0 F. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant’s representative, no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. The fire extinguisher was serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Administrator Mayrl Evangwlista was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant’s representative, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, May 15, 2024