Terra Linda Residential Care

Type of visit: Required - 1 Year

At approximately 11:30 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Administrator Lailani Cenzon arrived at 11:40 AM. Terra Linda Residential Care is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a two (2) story ranch house with all residents bedrooms on the first level. The facility has an approved fire clearance for six (6) non-ambulatory residents. The facility has a Hospice Waiver for three (3) residents. Upon arrival, LPA was informed that there were six (6) residents in care and two (2) staff members on-site. At approximately 11:45 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 11:50 AM, LPA toured the facility with Administrator Cenzon. All exits were clear and unobstructed. The facility's one (1) fire extinguishers were last serviced and tagged on 10/16/2024. The facility was sufficiently lighted. LPA inspected five (5) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. Per regulation, the facility should be conducting fire and emergency drills quarterly. The last disaster drill was conducted on 1/3/2025. This deficiency will be cited. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C.. ...Continued from 809 At approximately 12:35 PM LPA reviewed three (3) resident files. Three (3) of three (3) resident files were observed with all required documentation. LPA reviewed three (3) staff files. All staff files were observed to be well organized with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Lailani Cenzon’s Administrator Certification 7031312740 is current with an expiration date of 5/1/2027. LPA requested the following documents be submitted to Community Care Licensing by 11/7/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections and Appeal Rights discussed and provided to Administrator Cenzon. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 7, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 11/14/24 at approximately 1:35pm, and was greeted by caregiver Isabel. There are currently six (6) residents in care; Currently there are two (2) residents on hospice care. Administrator arrived to meet with the LPA. There is an approved hospice waiver for three (3) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Facility has an approved dementia plan of operation. Facility has a fire clearance approval for a total of six (6) non-ambulatory residents. The facility's last fire drill was held in October, and the evacuation drill is scheduled for 2024. Facility does have a generator for emergencies if needed. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. LPA reviewed five (5) resident files; All resident files were found to be complete. Medications were observed, and reviewed, including PRN medication records. LPA reviewed five (5) staff files. LPA reviewed staff training. All five(5) staff have criminal record clearance, and are associated as required. All staff had required training. All staff had current First Aid and CPR Certification. LPA observed sufficient supply of food, perishable and non-perishable, for resident meals/snacks. Facility had sufficient furnishings for residents in care. The facility has sufficient lighting in all rooms, bathrooms, and common areas, including night lights. There was a sufficient supply of hygiene products, cleaning supplies, and paper products for use as needed.Facility has a sufficient supply of personal protective equipment (PPE). All medications were stored/locked and inaccessible to residents in care. All cleaners/disinfectants were locked up inside the facility, and inaccessible to residents in care. Continued on LIC809C... All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed; Two resident rooms have access to a bathroom, with shower stall, that is right outside of their rooms. Three resident rooms have a private half bath, and one resident room has a full bathroom. There is a full bathroom in the long hallway for resident use as needed. LPA is requesting the following documents be updated and submitted by 12/14/24: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster The following deficiency was observed: LPA toured the facility property with the LPA and observed a large storage shed in the yard that had an accordion style door, it was broken and hanging on one side; The shed stored miscellaneous items, including disinfectants/cleaners. Administrator stated they would be fixing this storage door. The Administrator did have a lock on the door, but this was not sufficient security with the door being broken. LPA obtained photos. This deficiency will be cited, 87705 (f)(2)- Care of Persons with Dementia-The following shall be stored inaccessible to residents with dementia: Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights given to the Administrator. Exit interview conducted with Licensee/Administrator Lailani Cenzon.the state’s words, verbatim · CDSS document, Nov 14, 2024

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Cuadra arrived announced to conduct a Post-Licensing Inspection and met with Licensee/acting Administrator, Lailani Cenzon. Required postings were observed. The facility received an approved fire clearance dated September 5, 2023 that allows for six non-ambulatory residents. During Pre-licensing LPA discussed with Administrator about the importance to make the second floor area inaccessible for residents in care. Today, LPA/Administrator observed during touring of the facility that the access door located at the interior stairway is still without a lock. Per Administrator, the contractor is in the process of installing a door that it will be able to be locked. LPA will be issuing a technical violation for this issue. In the mean time, staff will ensure the area is inaccessible via observation. All resident rooms are furnished per regulation, the facility was comfortable temperature and passageways were free from obstructions. Bathroom showers have non-skid shower floor and grab bars. Water temperature read at 105.1, 105.4, 106.5, 106.7, 107.2 and 105.1 degrees F which is within regulation of 105 & 120 degrees F. Facility has a locked cabinet in the kitchen used for centrally stored medications. Files are stored in a locked office cabinet. Cleaning supplies and toxins are locked in a cabinet in the pantry and an outdoor locked shed. Perishable and non-perishable foods are stored per regulation. Facility has at least two days of perishables and seven days of non-perishables. Smoke and Carbon Monoxide detectors were tested and operational. Facility has a generator in case of a power outage. Activity calendar needs to be updated due to resident's interests. Continued on LIC809C... Continued from LIC809... Cameras were observed by LPA/Licensee in the common areas do not have audio. However, the use of cameras in the common area was not included in the admission agreements. The Licensee is required to update the facility's plan of operation when a new service is added and will elaborate an addendum to the resident's admission agreements. Licensee was given instructions of the Guidelines for Video Surveillance to assist in developing a policy. Licensee stated the cameras would be turned off at this time and would be reinstalled until a Video Surveillance policy is created. At approximate 9:30am LPA initiated file review of three residents and three staff. Admission Agreements were complete. Medical assessments and Care Plans for all residents were current. Two out of three staff do not have training hours complete. Staff have CPR/1st aid updated. Administrator certificate for administrator Lailani Cenzon 6067016740 expires on 5/1/25. Administrator had a discussion with LPA about changing administrators. LPA provided information regarding documents needed to perform the change of Administrator. Medication and medication records were reviewed. Licensee agreed to submit the following documents by 4/12/24: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Emergency Disaster plan (if there are any changes) and copy of Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with Licensee and copy of this report was given.the state’s words, verbatim · CDSS document, Apr 5, 2024

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: Prelicensing

Licensing Program Analyst (LPA) Victoria Bertozzi arrived announced to conduct a Pre-Licensing Inspection and met with Applicant, Lailani Cenzon. Applicant has applied for a Change of Ownership of an existing Residential Care for the Elderly Facility. Facility is a two story residence with six single bedrooms, six bathrooms, and common areas. The second story is designated as living space for staff. Residents will not reside or use the second floor. There is a door at the interior stairway that does not lock. To make areas that may pose a risks inaccessible to residents in care, LPA suggested the door be changed to a door that can be locked. In the mean time, staff will ensure the area is inaccessible via observation. All resident rooms are furnished per regulation with a bed, lamp, dresser, chair and bedside table. Bathroom showers have non-skid shower floor and grab bars. Water temperature read at 107 degrees F which is within regulation of 105 & 120 degrees F. Facility has sufficient items used for cooking and eating. Facility has a locked cabinet in the kitchen used for centrally stored medications. Files are stored in a locked office cabinet. Cleaning supplies and toxins are locked in a cabinet in the pantry and an outdoor locked shed. Perishable and non-perishable foods are stored per regulation. Facility has areas inside and outside for visiting and activities. LPA observed a camera in the kitchen and Applicant confirmed that the camera in the kitchen is active and the facility also has exterior cameras. LPA confirmed with Applicant that audio on the cameras were turned off to ensure resident's Personal Rights. Continued on LIC809C Continued from LIC809 Facility received an approved fire clearance dated September 5, 2023 that allows for six non-ambulatory residents. LPA and Applicant discussed the fire clearance request to retain a bedridden resident under the current license. Per Applicant, the individual no longer resides in the facility so a bedridden fire clearance is no longer needed. LPA discussed with Applicant the requirement of having a bedridden fire clearance prior to admitting a resident who is bedridden. Applicant understands. Facility has Smoke and Carbon Monoxide detectors that were tested during the fire inspection. LPA also tested the Carbon Monoxide detector during this inspection. Facility has a generator in case of a power outage. LPA confirmed with Applicant that they are signed up with the Guardian and Provider Information Notices (PINs). Component III was conducted with Applicant. LPA notified Applicant that once licensed, they will need to complete new Admission Agreements and Care Plans for all residents, LPA will notify Application Unit so application process may proceed.the state’s words, verbatim · CDSS document, Nov 13, 2023

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Name - Lailani Cenzon CEO/ Joel Trinidad Administrator Interview Method: Telephone interview On October 11, 2023, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and 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 the 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, Oct 11, 2023