Shady Oaks Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Peter Reboja, who stated the administrator would arrive shortly. LPA observed (2) residents present in the common area and (2) residents resting in their rooms. The facility is licensed for (5) non-ambulatory residents and has a hospice waiver for (2). Currently, there is (1) resident on hospice. LPA observed a hospice staff and Physical Therapist present during today's inspection. LPA and Administrator toured the interior/exterior of the facility including the common areas, (3) resident bedrooms, (2) full bathrooms, kitchen, and locked laundry area on the first floor. The second floor of the facility is used by the Administrator. LPA observed the bathrooms to have the necessary grab bars, skid-resistant flooring, hygiene supplies and trash can. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps and medications not requiring refrigerations are locked in the kitchen, and toxins are secured in the laundry area. Fire extinguisher was last serviced 9/22/2025, and the smoke monoxide alarms are working. There are required postings in the common area, including Resident Rights. The facility completed the last fire drill in January 2026. Inside temp measured 73*F . Hot water measured 127*F in a resident bathroom- a sign is posted. Facility to monitor the temperature monthly. There is (1) unlocked gate from the inside back patio. LPA reviewed (2) resident files and (3) staff files. Medications were reviewed for (2) residents- orders match medications being administered. Staff have current First Aid/CPR certifications. (2) staff have current RCFE Administrator certifications. Administrator RCFE Administrator certification #7003027740 (exp 2/10/2028). All staff is cleared/associated. LPA to provide additional resources by email. Discussed various topics also. Per California Code of Regulations Title 22, (1) deficiency is issued on the 809-D page. Exit interview. Copy of report and appeal rights provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 10, 2026

The state marks this report as 4 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

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Marjorie Reboja, Administrator, and explained purpose of inspection. LPA observed (2) residents present in the common area and (2) residents resting in their rooms. The facility is licensed for (5) non-ambulatory residents and has a hospice waiver for (2). Currently, there are no residents on hospice. Licensee, Fortunata Reboja, was outside sweeping on the patio and staff, Peter Reboja, was present also. LPA and Administrator toured the interior/exterior of the facility including the common areas, (3) resident bedrooms, (2) full bathrooms, kitchen, and locked laundry area on the first floor. The second floor of the facility is used by the Administrator. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels, soap and trash can. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and medications in the kitchen, and locked toxins in the laundry area. Fire extinguisher was last serviced 10/1/24 and the smoke monoxide alarms are working. There are required postings in the common area, including Resident Rights. The facility will complete a quarterly an emergency drill by 3/13/25. There are sufficient linens/towels/paper products/PPE. Inside temp measured 71*F . Hot water measured 110*F in the kitchen. Administrator to advise of any staffing changes. LPA reviewed (2) resident files which were to be organized. Both care plans to be current but will need updating by 3/19/25. (1) physician's report was current and Admin to request the second resident schedule a physical. (2) residents have doctors who visit in person. Medications were reviewed for (1) residents. Medications matched orders and Administrator will obtain a PRN order for an allergy medication for (R1) and will submit a copy of the prescription to Department. LPA reviewed (3) staff binders. All staff have current certification in First Aid/CPR- expires March 2026 . Administrator certificate #7003027740- exp 2/10/26; Administrator Designee/staff, has RCFE# 7010345740- exp 5/21/25. All staff is cleared and associated. There is (1) unlocked gate from the inside back patio. (2) light bulbs were replaced in a bathroom today. There are no deficiencies issued in this report. Exit interview. Copy of report provided to the Administrator.the state’s words, verbatim · CDSS document, Mar 6, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection to follow up on (2) incident reports received. LPA met with Marjorie Reboja, Administrator, and stated the reason for today's inspection. A required annual inspection was also conducted today. LPA and Administrator discussed the following incidences between residents (R1 and R2), as follows: On February 6, 2025, (R1) hit (R2) in the face after (R2) allegedly annoyed (R1) in their shared room. Neither resident was injured and the Administrator spoke to each resident about the reason for the occurrence. On February 13, 2025, (R1) hit (R2) again in the face after both residents were arguing with each other. The same day, (R1) moved to a private room and (R2) moved to a shared room with another resident. There have been no subsequent incidences since. The Administrator talked to both resident's responsible persons, and they agreed with the room change. They had only been roommates for about (2) weeks when the first incident happened. Administrator took (R1) to the emergency room following the second incident. (R1) was evaluated and returned the same day with no medication changes. (R1) has a diagnosis of Dementia. Administrator will update his care plan (due 3/19/25) and include these incidences. Administrator will continue to monitor them and let the families and Department know if there are any future incidences. There are no deficiencies cited in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Marjorie Reboja, Administrator, and explained purpose of inspection. LPA observed (4) residents present in the facility. The facility is licensed for (5) non-ambulatory residents and has a hospice waiver for (2). Currently, there are no residents on hospice. LPA and Administrator toured the interior and exterior of the facility including the common areas, (3) resident bedrooms, (2) full bathrooms, kitchen, and locked laundry area on the first floor. The second floor of the facility is used by the Administrator. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels, soap and trash can. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and medications in the kitchen, and locked toxins in the laundry area. Fire extinguisher was last serviced 8/25/23 and the smoke monoxide alarms are working. There are multiple Covid posters as well as other required postings in the common area. Facility conducts quarterly fire drills. There are sufficient linens/towels/paper products/PPE. Inside temperature measured 71*F and hot water measured 108*F in the kitchen. LPA reviewed (3) resident binders and found (2) care plans and (1) physician's report to need updating. Medications were reviewed for (2) residents. A technical advisory note is issued. LPA reviewed (3) staff binders. All staff are missing current certification in First Aid/CPR. Administrator certificate #6010895740 is pending renewal and #701034570 (exp 5/21/25) are posted. All staff is cleared and associated. There is (1) unlocked gate from the inside back patio. There are no bodies of water/pool. LPA reviewed/approved the Infection Control Plan. Emergency Disaster Plan is complete. LPA obtained an updated copy of current liability insurance, and requested LIC500 and LIC308 be submitted to the Department by 3/7/24. LPA to email some additional sample forms. There are (3) deficiencies issued on the 809D pages. Exit interview with Administrator. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 28, 2024