Stanford Crossings Care Home

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 10/16/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff persons, Kaye Elma and Joan Dickens, who were briefly interviewed at this time. This LPA requested that the facility staff go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. Current census was 5 residents. It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (5) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there was (1) resident receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry area, located in the room next to the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6066497740, for Cecil de Lara was observed to have an expiration date of 03/21/2027 and in compliance at this time. Medication cabinet, located in the facility kitchen cabinet , was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers were located throughout this facility and observed to have been annually inspected by the local fire extinguisher company, Joegensen & Co Fire Extinguisher Company, with the inspection date of 04/04/2025 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (5) facility personnel records was conducted on the LIC 859. A review of (6) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Oct 16, 2025

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 11/13/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated representative John Foronda. A brief interview was conducted with the facility designated representative at this time. Current census was 6 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 10/16/2024. This visit was to follow up on the Plans of Correction that were due. The following deficiencies were observed and cited on 10/16/2024: Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This facility did complete the Plans of Correction and provided all of the required forms and documents at this time. Plan of Correction clearance letters were printed and copies provided to the facility staff person at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 13, 2024

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 10/16/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Cecil de Lara, who was briefly interviewed at this time. Current census was 6 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (5) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there was (1) resident receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry area, located in the room next to the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6066497740, for Cecil de Lara was observed to have an expiration date of 03/21/2025 and in compliance at this time. Medication cabinet, located in the facility kitchen cabinet , was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers were located throughout this facility and observed to have been annually inspected by the local fire extinguisher company, Armor Fire Extinguisher, with the inspection date of 03/05/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (5) facility personnel records was conducted on the LIC 859. A review of (6) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Oct 16, 2024

Allegation investigated: Facility is not allowing resident to have visitors or take telephone calls

Unannounced complaint visit made out to this facility on 05/16/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated staff person, Cecil De Lara, who was briefly interviewed at this time. Current census was 6 residents. The purpose of this visit was to deliver the findings of this investigation to this facility and it's designated staff person at this time. Based on interivews conducted during the course of this investigation, it was learned that R1 moved into this facility from the bay area for personal reasons. It was learned that R1 had suffered through several medical conditions which required R1 to maintain rest and reduce the amount of stress on R1's mental and physical state. As a result, it was recommended by R1's attending physician that R1 reduce the amount of exposure to external stressors and situations. It was learned that this limited the amount of visitations and interactions on the telephone for R1. Based on interviews conducted, this facility was abiding by the recommendations from R1's attending Unsubstantiated physician, as well as, the rights exercised by R1 himself. Based on a review of the forms and documents, it was learned that R1 personally penned several letters expressing R1's rights to refuse to speak on the telephone nor interact with certain named individuals. It was learned that there were only a few individuals with whom R1 wanted to interact with or have any contact while residing at this facility. This facility was respecting the wishes and rights of R1 and supported R1's refusal to speak with certain individuals and R1's Rights to refuse visitation from certain individuals. As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at the time of this complaint visit. Exit Interviewthe state’s words, verbatim · CDSS document, May 16, 2024 · control 27-AS-20240305101809

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 01/05/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated representative, Cecil De Lara, who was briefly interviewed at this time. It was learned that this facility just recently discovered that one of their residents had just tested positive for COVID and was taking the necessary steps for isolation and quarantine at this time. This facility was observed to be following the COVID policies and procedures by donning masks and taking temperatures at the entry way into this facility. It was unsure at this point if other residents had tested negative or were positive. It was also unsure as to the status of the facility staff who were present at this time as well. As a result, and for precautionary reasons, this LPA did not conduct this Post Licensing visit at this time. This LPA informed the facility representative to keep this LPA updated as to the status of the residents and if there are any new COVID related cases. This LPA will be back out, at a later date, to conduct and complete this Post Licensing visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 5, 2024

Type of visit: Prelicensing

On 10/05/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to conduct a Pre-Licensing visit. LPA was greeted by Licensees, Enjola Elma, Cecil Delara, and Orchid Damrichob. The facility intends to hold 6 elderly residents, all of which may be non-ambulatory. This facility has a dementia plan on file and has a hospice waiver for 5. Current census was 0. Facility Designated Administrator has a current and active certificate #6062089740 and expires on 02/10/2024. The fire extinguisher, located throughout the facility was serviced on 02/17/2023 by Armor Fire and is in compliance at this time. Carbon Monoxide and smoke detectors were present and in good repair. Common areas for resident use were toured. Furniture and furnishings were observed to be present and in compliance. A tour of the bathrooms was conducted. Hot water temperatures were taken to ensure that the hot water being dispensed was within the allowed range of 105-120 degrees at this time. Grab bars were present and functional. Resident bedrooms were toured. Furniture and furnishing were observed to be present and in good condition. A linen closet was located in the hallway. LPA observed a sufficient amount of linens at this time. The kitchen area was toured. Facility freezer and refrigerator showed to be functional and in compliance at this time. A tour of the pantry was conducted. LPA observed that there was a 7-day nonperishable food supply at this time. Garage area was toured. Laundry detergent and cleaning supplies were locked and made inaccessible at this time. Additional Freezer was identified. This facility will be using a medication cabinet which was located in the kitchen. First aid kit was observed to be present and contained all of the required components at this time. Laundry room was toured. Additional linens were identified. Exterior grounds of this facility was toured. Perimeter fence and gates were observed to be functional and in good repair at this time. This facility has been observed to be in compliance at this time. There were no deficiencies observed during the course of this Pre-licensing visit. Applicant has already conducted Comp I and Comp II. Comp III was reviewed with applicant. Exit Interview was conducted and a copy of this report was provided to the applicant at the end of the visit.the state’s words, verbatim · CDSS document, Oct 5, 2023