Sgs Care Home I

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. Administrator (AD) Gladys Stanfield was unable to attend in person but joined the inspection via phone. Facility Designee, Imelda Balallo joined LPA in person for the visit. During this visit, LPA toured the facility inside & out. Resident rooms and common areas were clean, in good repair and contained required furnishings and lighting. LPA observed required items in bathrooms which were clean with hot water measuring 115 degrees. LPA observed hygiene items, paper products, towels, extra bedding, and linens which were available for use. The kitchen was clean, containing necessary cooking items and appliances. LPA observed required food supply, including emergency food. Medications are centrally stored in a locked cabinet in the dining area. Knives/sharps, cleaning/disinfecting supplies chemicals are inaccessible and stored away from food in the garage. Doors and passageways are unobstructed throughout the facility including outdoors. First aid kit contained required items. LPA walked outside to find the grounds well-kept with patio and seating areas. A self-releasing gate was working properly. The fire extinguisher was serviced 5/4/26 by Jorgensen. LPA conducted resident and staff file reviews including a medication audit. Emergency Disaster & Infection Control Plans were reviewed. Fire Drills are up to date. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D An exit interview was conducted, a Plan of Correction was developed with AD and a copy of this report was provided. SEE LIC809-C FOR CONTINUATION OF THIS REPORT Page 2 LPA observed the following deficiencies during today’s inspection: -R1 has an exposed leg injury or wound requiring medical assessment -Over the counter medications were accessible in common area to residents in care -Staff did not document resident PRN medication use as required -Resident files were not complete and current (Physician Reports and Care Plans) -Spoiled produce was observed LPA requested the following updated forms faxed to CCLD by 8/___- Infection Control Lead Certification, Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Client Roster (LIC 9020) and Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Aug 4, 2026

The state marks this report as 12 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility to conduct an unannounced Annual Inspection. LPA met with Administrator (AD) Gladys Stanfield. LPA began the tour by entering through the front door of the 4 bedroom – 2.5 bathroom – one story home. All required postings were hung. Common areas were found to be well lit with ceiling fans throughout. Furniture was observed to be properly spaced and in good condition. Flooring is intact throughout the home. Smoke and Carbon Monoxide detectors were tested and found to be I working order. The Fire Extinguisher was serviced 4/14/25 by Jorgenson Co. LPA observed additional supply of paper products, bed linens, towels, personal hygiene/grooming products. Resident rooms are found to be in good repair and contained required linens, furnishings, and lighting. The resident bathrooms are clean, in good repair with grab bars and faucets delivering hot water at 117 degrees. The kitchen was observed to have a supply of dishes, plates, utensils, and cooking items. Food storage areas are clear and appropriate for food preparation. Cleaning supplies, chemicals, and sharps/knives are all locked as required. Appliances were found to be in working order. LPA observed the required food supply. Resident medications are stored in a locking cabinet. The First aid kits contained the required items. Doors and passageways are unobstructed throughout the inside of the home. Outside of the facility was toured. There is a covered seating area and a gate that needed minor repair. There is a shed on the side of the home which was locked. LPA observed inside and observed furniture and yard item storage. Emergency Disaster and Infection Control Plans were reviewed. No deficiencies were cited on this day. Facility to provide LIC500 and Insurance Surety Bond to be provided by 09/25/2025. An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Sep 11, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct a Pre-Licensing Inspection. LPA met with Administrator (AD) Gladys Stanfield. LPA began the tour by entering through the front door of the 4 bedroom – 2.5 bathroom – one story home. All required postings were hung. Common areas were found to be well lit with ceiling fans throughout. Furniture was observed to be properly spaced and in good condition. Flooring is intact throughout the home. Smoke and Carbon Monoxide detectors were tested and found to be I working order. The Fire Extinguisher was serviced 2/27/24 by Jorgenson Co. LPA observed additional supply of paper products, bed linens, towels, personal hygiene/grooming products. Resident rooms are found to be in good repair and contained required linens, furnishings, and lighting. The resident bathrooms are clean, in good repair with grab bars and faucets delivering hot water at 110 degrees. The kitchen was observed to have a supply of dishes, plates, utensils, and cooking items. Food storage areas are clear and appropriate for food preparation. Cleaning supplies, chemicals, and sharps/knives are all locked as required. Appliances were found to be in working order. LPA observed the required food supply. Resident medications are stored in a locking cabinet. The First aid kits contained the required items. Doors and passageways are unobstructed throughout the inside of the home. Outside of the facility was toured. There is a covered seating area and a self-releasing gate found to be working properly. There is a shed on the side of the home which was locked. LPA observed inside and observed furniture and yard item storage. LPA called and confirmed the facility phone number by calling (559) 389-0953. See LIC809C for continuation of this report Emergency Disaster and Infection Control Plans were reviewed, and COMP III was conducted during this visit with AD. The applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued. An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Aug 14, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Gladys Stanfield Interview Method: Telephone interview On July 26, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditionsthe state’s words, verbatim · CDSS document, Jul 26, 2024