St. Cecilia's Senior Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual inspection. LPA was greeted by staff and explained the reason for visit. Administrator Tiffany Vander Poorten arrived shortly after to assist. The facility is licensed to serve 6 non-ambulatory residents aged 60 and over with hospice approved for six. There are currently four (4) residents in care, two (2) of which receive hospice services. The facility is operating within the scope of their license. The facility is a single-family home located in a residential area of Glendora. The home consists of a living room, family room, kitchen, four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, front yard, backyard, and detached garage. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded area located in the backyard with sufficient seating for residents in care. Passageways and exits are free of obstruction. The water temperature was tested in all three (3) bathrooms and measured within the required 105° F - 120° F. LPA observed grab bars and non-skid mats in both the bathrooms. continued on LIC 809C Smoke detectors were observed throughout the facility. The carbon monoxide detector is located in the hallway, was tested and is operable. Fire extinguisher was observed located near the kitchen. Emergency drills are conducted quarterly, last drill was conducted in January 2026. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are inaccessible to residents. Cleaning supplies and disinfectants are locked and inaccessible to the residents. Sufficient supply of 2 days perishable and 7 days non-perishable foods were observed. Dining area was clean and had sufficient seating. Fireplace located in the family room had a cover making it inaccessible to residents in care. Living room and family room were clean and free of obstructions and have sufficient seating. Medications are centrally stored in a cabinet in the kitchen. Medications are documented properly. Resident bedrooms have all require furniture which includes, for each resident, a bed, a chair, night stand, a lamp, or lights sufficient for reading. Bed linens were clean and in good repair. There is closet space for clothing and other belongings. Hall closet contained extra clean linens. Four (4) resident and three (3) staff files were reviewed and were observed to contain required documentation. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were cited during today’s visit. Exit interview held and a copy of this report was provided to Administrator Tiffany Vander Poorten.the state’s words, verbatim · CDSS document, Feb 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met Caregiver Marivic Vigilla at approximately 12:00 PM and explained reason for visit. Administrator Tiffany Vander Poorten arrived shortly. The facility is licensed to serve 6 non-ambulatory residents aged 60 and over with hospice approved for six. Currently, there are three (3) residents on hospice The facility is in a residential area, and it is a one-story family home. A tour of the single-story facility included the living room, family room, kitchen, 4 resident bedrooms, 1 staff bedroom,3 bathrooms, laundry area, front yard, backyard, and detached garage. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, light, and sufficient closet space. The resident bathrooms have the required grabs bars and non-skid mat. The hot water was 126.5, 126.5, and 125.9 degrees not within the required 105 - 120 degrees. Cleaning supplies were observed to be accessible to residents under bathroom sink. The kitchen was inspected. There is sufficient non-perishable food. It was observed that facility did not have enough two-day perishable food. All the appliances are clean and seem to be operating properly. The common areas include the living room and dining area. These areas are clean and have the required furniture. LPA reviewed 6 resident records to confirm emergency contact is updated and residents have health screenings on file. Four staff records were reviewed to confirm health screenings, training and fingerprint clearances. LPA reviewed 6 residents' medications. Medications are documented properly and given as prescribed. Deficiencies noted. Exit interview and a copy of this report, 809D and appeal rights was provided to Administrator.the state’s words, verbatim · CDSS document, Feb 25, 2025

Allegation investigated: Staff did not follow Physicians orders

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Tiffany Vander Poorten and explained the reason for the visit. The investigation consisted of the following: LPA conducted interviews with Administrator Tiffany Vander Poorten, Staff 1-2 (S1-2) and Residents 2-6 (R2-6). R1 was not interviewed as resident is currently in the hospital. LPA interviewed R4's Family Member (R4 FM). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file and collected copies of documents pertinent to the complaint investigation. LPA conducted phone calls with R1's Family Members 1-2 (R1 FM1-2) and Global Home Hospice Service, Inc, Director of Nursing Soo Kim. (See LIC9099C for continuation) Unsubstantiated Investigation revealed the following: Staff did not follow Physicians orders, it is alleged that facility staff were giving R1 more medication (Ativan) than what their doctor prescribed. It is also alleged that R1 quickly deteriorated after admission to the facility. R1 allegedly lost weight, was sedated all the time and was unable to carry a conversation. Interview conducted with Administrator Tiffany Vander Poorten and staff revealed that facility staff administer medications to residents as prescribed by their doctors. Staff indicated that they provide residents with their medication per their physician’s orders. Administrator stated that R1's family did not want R1 taking Ativan as prescribed by the doctor. She stated that it was explained to R1's family that the facility ensures to administer medication as prescribed. Administrator and staff denied that R1 was sedated all the time. Staff stated that they ensure that residents eat all their meals and if they notice significant weight loss they ensure that the resident is seen by their doctor. Administrator stated that R1 had just been admitted to the facility on 05/08/24, was diagnosed with Major Neurocognitive disorder and had symptoms and behaviors pertaining to that diagnosis. She stated that staff would assist R1 out to the dining room to have their meals, as well as out to the living room to interact with other residents. She denied that R1 quickly deteriorated after admission to the facility and stated that when staff observed that R1 was not feeling well they informed the family and the family then decided to take R1 to the hospital and not discharge them back to the facility. Record review revealed that Ativan was a prescribed medication for R1 under their Hospice Agency standard order with an effective date of 05/17/24. Upon R1’s admission to the facility, R1’s Responsible Party R1 FM1 signed all the Hospice documentation that indicated that they were aware of R1’s Plan of Care which included R1’s prescribed medications. Interviews with 4 out of 5 residents revealed that they get their medications on time everyday and they do not have any concerns. They stated that they do not have any complaints and are satisfied with all services received. 1 resident was not interviewed as resident is non-verbal. LPA interviewed Global Home Hospice Service, Inc, Director of Nursing Soo Kim who stated that the facility was following physician's orders. R4 FM stated that R4 has lived at the facility for 6 years and they are satisfied with all services, has no concerns and the facility follows all doctor's orders as the facility is in constant communication with the family regarding anything to do with R4. Based on interviews conducted with facility staff, facility residents, hospice agency staff, resident family members and LPA review of documents there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held. A copy of the report was provided to Administrator Tiffany Vander Poorten.the state’s words, verbatim · CDSS document, May 30, 2024 · control 28-AS-20240528120300

Type of visit: Required - 1 Year

Licensing Program Analyst's (LPA's) Val Maldonado and Tyler Reyes made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA's Maldonado and Reyes met with Administrator, Tiffany Vander Poorten, and explained the purpose for the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Administrator, observed the facility food supplies, reviewed (6) resident medications, (6) resident files, (3) staff files, and conducted interviews with (3) staff, and attempted interviews with (6) residents. The facility is a single-story home, operating as a Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. There is a fire clearance approved for (6) non-ambulatory residents. It has an approved Dementia Care Plan and a Hospice Waiver approved for (6) residents. There are currently (2) resident receiving hospice services. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review. The facility has an active and current liability insurance policy on file. At about 9:10AM, upon entry to the facility, LPA's Maldonado and Reyes observed surveillance cameras in the dining room, living room, and TV room. This facility does not have approval to have surveillance cameras in use. LPA observed all resident bedrooms to have the required furniture, sufficient lighting, and closet/storage space. There are (2) full bathrooms in the home. (1) bathroom is designated for resident use and one for staff/visitor use. Resident bathroom is equipped with required grab bars and non-skid mats for the shower. The hot water was tested and measured at 112.8*F, which is in compliance. Food supplies was observed and was sufficient as required. Emergency food supplies and water were available. First aid kit and manual were observed. There were no bodies of water observed on the premises. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to residents in care. The last fire drill was conducted in January 2024. Auditory devices were observed at all entrances/exits of the home and were operational. Smoke/carbon monoxide detectors were tested and observed to be operational during the visit. (6) resident files and (3) staff files were reviewed and observed to be complete with all required documentation. (6) resident medications were reviewed and were observed to be documented properly and given as prescribed. Per California Code of Regulations, Title 22, deficiencies were observed and cited on the LIC809-D. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 5, 2024