Southland Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 10:56 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Ana Martinez, Administrator and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on 07/14/2025. The facility is a four (4) bedroom and three (3) bathroom facility currently occupying four (4) residents. There are two (2) additional restrooms inaccessible to residents and for staff only. The facility has hard wired, dual smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid flooring. The pathways are clear of any obstructions. Disinfectant, cleaning solutions are inaccessible to residents in care locked and stored in the laundry room and or locked under kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. Operational Requirements: The facility has current liability insurance. The facility has a current plan of operation on file with the department. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of four (4). Fire clearance is granted for four (4) Ambulatory of which three (3) may be non-Ambulatory and one (1) may be bedridden. Staffing, Personnel Records & Training: The facility currently employs six (6) full-time staff, 2 part-time staff, one (1) registered nurse, one (1) Facility Manager and one (1) administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, and Health screening with TB results. Administrator Certificate expires 06/11/2027. Staff have annual training for various subjects/topics for 2025 and 2026. Continued on 809-C Additional topics on Dementia care were requested in a Technical Violation during 2025 annual visit, facility did not meet the required annual hours for dementia during this annual visit, citation given. Medication training on two (2) staff who assist in medication was reviewed. Training for medication has not been done since 2024, annual training is required. Facility has scheduled Medication training for May 19th and 20th, due to the delay in the training a citation is issued. Resident Records & Incident Reports: Facility does submit incident reports to the department when required. LPA reviewed four (4) resident files, for but not limited to signed Admission Agreements, Personal Rights, Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, (TCRC IPP), Emergency and ID forms, all forms were legible. Facility utilizes different forms for the Physician Assessment, which is missing details typically reviewed by the LPA. Technical given to request additional items be reviewed prior to admitting a resident and annual thereafter. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. All food is covered, stored, and marked appropriately. Kitchen is clean, no evidence of insects or rodents. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR). Facility does not utilize the state’s Centrally Stored Medication and Destruct Records (CSMDR), but does keep records noted in regulation. Updates to their processes were requested to ensure all items were documented for CSMDR requirements. LPA reviewed residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts monthly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 2 self-latching gates on each side of the home. The facility does not have delayed egress, locked doors or gates. Exit interview conducted and copy of appeal rights and report printed for Administrator.the state’s words, verbatim · CDSS document, May 12, 2026

The state marks this report as 13 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 8:15 am and made an unannounced 1-year required annual visit to the facility above. LPA’s met with Nereida Leal, back-up Administrator and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on 08/23/2024. The facility is a four (4) bedroom and three (3) bathroom facility currently occupying four (4) residents. There are two (2) additional restrooms inaccessible to residents and for staff only. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid flooring. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions are inaccessible to residents in care locked and stored in the laundry room and or locked under kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has current liability insurance and expires on July 1, 2025. The facility has a current plan of operation on file with the department. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of four (4). The fire clearance is granted for four (4) Ambulatory of which three (3) may be non-Ambulatory and one (1) may be bedridden. Continued on 809-C Staffing, Personnel Records & Training: The facility currently employs five (5) full time staff, 2 part time staff, one (1) designee, one (1) registered nurse, one (1) Facility Manager and one (1) administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator Certificate expires January 26, 2027. Staff have annual training completed for various subjects/topics for 2024 and 2025. Additional topics for Hospice and Postural support are being scheduled. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed four (4) resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, (TCRC IPP), Emergency and ID forms, all forms were legible, and records are kept confidential. Facility keeps cash resources for residents which was reviewed and complete. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts monthly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 2 self-latching gates on each side of the home. The facility does not have delayed egress, locked doors or gates. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, May 22, 2025

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff are not following food safety protocols for residents in care.

At 10:08 am on 10/1/24, Licensing Program Analyst (LPA) M. Rankin conducted a required 10 Day Complaint visit. LPA met with House Manager (HM) Nereida Leal who accompanied LPA on the inspection. At 10:40 am LPA met with Administrator Ricardo Navarro to review report. At time of visit, 1 HM, 1 caregiver and the administrator were at the facility, and there were 2 residents present. On the allegation: Staff are not following food safety protocols for residents in care the following was determined. Continued on 9099-C Substantiated At 10:13 am LPA conducted a tour of the kitchen area and inspected all food in the refrigerator and freezer and found that at time of visit all items were properly labeled, no expired food was found in the refrigerator and all vegetables were fresh with no evidence of decay. LPA at 10:20 am reviewed pantry area and found a package of chocolate chips with an expiration date of 8/16/24, a package of Pumpkin Spice Pancake mix with expiration date of 7/12/24, and a package of Croutons, with expiration date of 10/6/23. At 10:27 am LPA reviewed cabinet with canned and jarred goods and found 2 jars of Country Gravy with expiration date of 9/15/24. (Pictures taken of all items.) At 10:41 am LPA discussed the allegations with the Administrator. The complainant stated on 9/24/24 a visit was done by the local ombudsman. Complainant stated the following: “observed several food items in the refrigerator that were not properly wrapped or labeled, including bacon and salami, pizza slices dated 9-12-24, cut lettuce that was turning brown, and a bag of green squash with at least one that was very soft." Picture evidence of expired food was provided to CCLD. At this time based on the evidence provided by the complainant, training records provided by facility of expectations, interviews conducted with HM and administrator, and the items found at time of visit by the LPA, the complaint is Substantiated. During preparation for visit LPA viewed facilities history and noted a prior deficiency on 7/1/24 for same Title 22 regulation 87555(a). LPA determined this is a repeat violation and an Immediate Civil Penalty of $250 was assessed for the Repeat Violation. During inspection LPA stated to HM that the training document provided to LPA for prior deficiency had specific requirements regarding how often staff will be inspecting food. The document emailed to LPA on 7/8/24 was, Training In-Service Record document, with title Agenda “Food Safety” dated 7/3/24 which was given to clear prior deficiency, noted the training included: “1. All food stored in refrigerator will be checked for expiration by NOC staff every other day. 2. Food stored in refrigerator will be thrown out after 2 days of being prepared regardless of being staff or house food. 3. NOC staff will check dry goods for expiration every Wednesday and throw away any expired food.” Six (6) staff noted receiving this training. Continued on 9099-C House manager and Administrator both stated they will be “purchasing a small staff refrigerator to separate items that belong to staff”. HM stated, “part of the food found are staffs”. Administrator stated they will conduct training with all facility staff, additionally administrator will do weekly checks of food to ensure staff are following training and regulations. Administrator will provide in-service training document signed by all staff as Plan of correction to LPA. An exit interview was conducted, Citation and Civil Penalty Fee given, and Appeal Rights were discussed with Licensee. Report was provided to Licensee. Please see 809D for citation and LIC 421FC for Civil Penalty Assessment.the state’s words, verbatim · CDSS document, Oct 1, 2024 · control 29-AS-20240927102202

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Oct 18, 2024

87555 General Food Service Requirements (a) The total daily diet shall be of the quality... necessary to meet the needs of the residents... All food shall be selected, stored, prepared, and served in a safe and healthful manner. This requirement is not met as evidenced by: Based on interviews, and observation, the licensee did not comply in the section cited above as spoiled/expired food was found which poses a health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 1, 2024

Plan of correction: Licensee agrees to provide training. Facility will provide document with staff signatures of those who attended. Additionally, Administrator agrees to conduct weekly food check to ensure food management is being upheld. Documentation will be submitted to LPA via email no later than 10/18/2024.

Allegation investigated: Staff are not following food safety protocols for residents in care.

Licensing Program Analyst (LPA) Rankin conducted a 10-day complaint visit to the facility above. LPA met with back up Administrator and explained the purpose of the visit. On the allegation, staff are not following food safety protocols for residents in care. LPA toured kitchen area, interviewed a residence and the back-up administrator. At the time of visit LPA went through the refrigerator to inspect all food items. LPA found a spoiled cucumber, expired mixed salad greens, as well as expired yogurt. Pictures were taken of expired items. A storage container was also found, dated 6/19/24 with rice inside. LPA observed a sign on the refrigerator directing staff to Continued on 9099-C Substantiated “Please throw away any made food within the 2 days it was made” as well as “Please make sure that all food is to be labeled with the date it was made....opened..." LPA also inspected a large sampling of dry goods and found 3 items expired from within the past month to 6 months. LPA requested the following documents: 3 staff files for review of training, and a copy of the menu. Training documents showed training was done during orientation regarding preparation and resident support for special diets. Based on interviews conducted and observations made, the allegation that facility staff are not following food safety protocols for residents in care is Substantiated at this time. The following deficiencies were observed (see LIC 9099-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were issued at the time of the visit.the state’s words, verbatim · CDSS document, Jul 1, 2024 · control 29-AS-20240624153403

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555 · Plan of correction due date: Jul 8, 2024

Type B 87555 (a) The total daily diet shall be of the quality... necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by: Based on interviews, and observation, the licensee did not comply in the section cited above as spoiled/expired food was found which poses a health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 1, 2024

Plan of correction: Licensee agrees to provide a written statement to CCLD acknowledging regulation 87555 and how the facility will regulate food compliance going forward. Plan will be submitted to LPA via email no later than 7/8/2024.

Allegation investigated: Staff are not properly storing residents' medications.

Licensing Program Analyst (LPA) Rankin conducted a 10-day complaint visit to the facility above. LPA met with back up Administrator and explained the purpose of the visit. On the allegation staff are not properly storing residents' medications. LPA toured kitchen area where medication is stored. At time of visit medication cabinet and lock box inside refrigerator were found secured and locked in compliance with regulations. Other areas were inspected for required securing of items, all areas were found in compliance at time of visit. Review of staff files for training found that the appropriate training was done during orientation regarding safeguarding medication and handling of medication. Continued on 9099-C Unsubstantiated LPA suggested a review of medication and the importance of consistently securing them be done during this years annual training for a reminder of this regulation and its importance. Based on the records obtained and observation on the day of LPA’s visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted, copy of report printed and provided to Back-up Administrator.the state’s words, verbatim · CDSS document, Jul 1, 2024 · control 29-AS-20240624153403

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 8:26 am and made an unannounced 1-year required annual visit to the facility above. LPA’s met with Nereida Leal, back-up Administrator and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants sprays and cleaners. The facility has a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: The fire extinguishers were last charged and inspected on May 18, 2022. Administrator immediately called for an inspection to be completed and will provided proof of new inspection as soon as completed. All trash cans and wastebaskets have tight fitting covers. The facility is a 4 bedroom and 3 bathroom facility currently occupying 4 residents. There are 2 additional restrooms inaccessible to residents and for staff only. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Continued 809-C Disinfectant, cleaning solutions are inaccessible to residents in care locked and stored in the laundry room and or locked under kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has current liability insurance and expires on July 1, 2024. The facility has a current plan of operation on file with the department. The Facility is not operating in compliance with the granted fire clearance. The facility is approved for a capacity of 4. The fire clearance is granted for 4 Ambulatory of which 2 may be non-Ambulatory. However, facility currently has 2 Ambulatory, 1 non-Ambulatory and 1 Bedridden resident. Staffing: The facility currently employs 6 full time staff, 1 part time staff and 1 administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. Administrator Certificate expires January 26, 2025. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023 and 2024. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, (TCRC IPP), Emergency and ID forms, all forms were legible, and records are kept confidential. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Continued 809-C Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents medications, no labels were altered, no medications were expired and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill March 9, 2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 2 self-latching gates on side of the home. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report and appeal rights printed for Administrator Civil Penalty issued (see LIC 809D).the state’s words, verbatim · CDSS document, May 24, 2024