Shiloh Living

Type of visit: Required - 1 Year

On 6/4/2026, Licensing Program Analyst (LPA) Mia Lankford conducted an unannounced required annual visit at the above facility. LPA met with Licensee Mark Anderson and explained the reason for the visit. Facility Overview: The facility is made up of a one-story home with five (5) bedrooms, four (4) bathrooms, a living room, dining room, kitchen, attached garage. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department's requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen door and inaccessible to clients. The smoke detector and carbon monoxide detector were in good working condition. LPA observed fire extinguisher to be in compliance with the department's requirements and with an expiration date of7/16/2027. The water temperature was tested and within regulations at 108 degrees. Continued 809-C...... Cont... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate expires 8/3/2027 and a CPR certification with the expiration date of 7/17/2027. Record Review and Resident/Staff Files: LPA reviewed files for two (2) staff members, confirming criminal clearance, updated training, and CPR/First Aid certification. Two (2) clients files were reviewed and contained all required documentation. LPA observed first aid kit to be locked and inaccessible to the clients in care. The clients and staff files were inaccessible to unauthorized individuals. Health-Related Services/Incidental Medical Services: All residents medications were securely locked in a cabinet in the hall area. LPA reviewed medications for two (2) clients, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on 5/4/2026, meeting department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Licensee, Mark Anderson.the state’s words, verbatim · CDSS document, Jun 4, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Javina George made an announced visit to the facility for the purpose of conducting a prelicensing inspection. LPA met with Licensee Mark Anderson and whom accompanied LPA for the duration of the inspection. On 2/7/24 the city of La Quinta Fire department granted a fire clearance, that will allow the home to be licensed to have six (6) non-ambulatory residents, with an approved hospice waiver for 2. The facility is a single story home with five (5) bedrooms, and four (4) bathrooms, attached garage, kitchen, backyard, and great room/family room. LPA conducted a tour of the interior and exterior of the facility. The following was observed during today's inspection: The facility has a sufficient supply of dishes, cooking and eating utensils, and linens that were observed to be in good repair. The facility food supply was observed to be sufficient as there was 2 day supply of perishable and a 7 day supply of nonperishable food items. The facility has an emergency food and water supply. The bathrooms were equipped with grab bars and non skid mats. The hot water was tested in all four bathrooms and measured to be between 113.9-117.5 degrees Fahrenheit. There are no pools or bodies of water on the premises. The passageways, and ramps/inclines were clear and free from obstruction. The home has five (5) fully charged fire extinguishers. There are smoke and carbon monoxide detectors strategically placed throughout the facility that were tested and observed to be operable. The facility does not have any known guns or ammunition stored on grounds. The sharps/knives, and chemicals are stored in a locked cabinet inside the laundry room. The medications will be kept in lock boxes, that will stored in a locked cabinet inside the great room/living room. LPA observed for the rooms to be fully furnished with a bed, lamp, night stand, and adequate lighting. The hallways had adequate lighting equipped with night-lights. The facility has working flashlights easily accessible (plugged into the outlets) to use in the event of a power outage. The facility was observed to have the required postings (resident council, theft and loss policy, personal rights, PUB475 CCL complaint poster. The Long term Care Ombudsman poster is posted on the wall in the dining room. The facility was observed to have several activities to encourage socialization such as, puzzles, bingo, as well as a covered patio with plenty of outdoor space including a putting green. It is the recommendation that the home be licensed once the following is completed: -Successful completion of COMP III orientation, (scheduled 6/14/24) -Complete first aid kit-items needed: thermometer, tweezers, gauze), and current first aid manual-ordered and will be delivered tomorrow 6/13/24, per receipt reviewed -Sharps/bio hazardous container-ordered and will be delivered tomorrow 6/13/24, per receipt reviewed -Liability insurance (pending license number) An exit interview was conducted and a copy of this report was provided to Mark Anderson, Licensee/Administrator.the state’s words, verbatim · CDSS document, Jun 12, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Mark Anderson, Managing Member/Administrator Interview Method: Telephone interview On 5/20/24, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/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 Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 20, 2024