Terra Verde Living

Type of visit: Required - 1 Year

On 5/21/2026, At 11:20 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced annual comprehensive inspection. Upon arrival, LPA was greeted by Support Staff Jeno Benosa. LPA explained the purpose of the visit and was granted access into the facility. The facility is licensed to serve (6) elderly adults aged 60 and above of which (6) can be non-ambulatory which (1) may be bedridden in bedroom #1 or #2. Facility has an approved hospice waiver for three (3). The facility is a single-story structure located in a residential neighborhood. The home consists of six (6) bedrooms two (2) bathrooms, living/dining room area, Kitchen, family room ("Sunroom"), laundry area and a two-car (2) detached garage along with two shaded areas with seating in the front yard and back yard. At 11:45 PM, LPA reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings which all appeared to be current. At 12:30 PM, LPA reviewed three (3) residents files for admission agreements, updated physician reports, and needs and services plans which all appeared to be current. LPA also conducted an audit of three (3) residents’ medications, and it appears that residents are given their medications as prescribed by their physicians. At 1:00 PM, LPA Allen and Tina Cinco- Licensee toured the physical plant. There were no bodies of water or obstructions on the premises Continued LPA inspected a total of six (6) bedrooms. Two (2) of which are assigned to staff members and two (2) bathrooms. The beds and bedding supplies appeared to be in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were in good condition and operational. The water temperature ranged from 105°F to 120 °F. LPA observed that the facility appeared to be clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was a 5-day supply of perishable and a 7day supply of non-perishable food items available, which was adequately maintained/stored. The fire extinguishers were fully charged; carbon monoxide detectors and smoke detectors were fully charged and operable. The last Fire/Disaster drills were conducted on 5/6/2026. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to Tina Cinco- Licensee at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 21, 2026

Type of visit: Required - 1 Year

On 07/18/25, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced, annual, required visit using the CARE Inspection Tool. LPA was met by staff two, Jeno Benosa - House Manager (S2) and LPA explained the purpose of today’s visit. LPA was later met by staff one, Tina Cinco - Licensee (S1) and staff three, Tiny Layug - Administrator (S3). The facility is licensed to serve (6) elderly adults ages 60 and above of which (6) can be non-ambulatory, of which (1) may be bedridden in bedroom #1 or #2. Facility has an approved hospice waiver for three (3). The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes along the west side of the facility. It consists of six (6) bedrooms (four (4) for resident use, two (2) for staff use), two (2) bathrooms, shaded back yard with seating, shaded front yard with seating, Kitchen, living room, family room ("Sun room"), laundry room and a two-car (2) detached garage. LPA and S1 toured the physical plant. There were no bodies of water or obstructions on the premises. LPA observed two (2) window screens in disrepair, please see LIC809-D. A total of four (4) resident bedrooms and (2) bathrooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. The facility presents a comfortable indoor temperature at 73.4゜F (degrees Fahrenheit) and hosts two (2) fire extinguishers, which showed the last annual maintenance having been performed on 10/08/24. Smoke and carbon monoxide detectors are all in operable condition. LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed. Cleaning supplies, toxins, and sharps objects were observed under the sink, unlocked, in bathroom one (#1). Please see LIC809-D. The kitchen was inspected and there is, at least, two (2) days of perishable and seven (7) days of non-perishable food is available and has been maintained properly. Report continues, please see LIC809-C. LPA reviewed (3) Medication Administration Records (MARs), no discrepancies were found. LPA observed the facility remains under infection control practices, as the facility appears to be in a clean and working condition. Staff have documented all six (6) residents AM and PM body temperatures. All mandated inspection control posters were posted throughout the facility and a copy of liability insurance, valid through 09/04/25, was provided to LPA during today's visit. LPA also verified this facilities' Annual Fee(s) as being current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed two (2) deficiencies. Please see LIC809-D. An exit interview was held with staff one, Tina Cinco - Licensee (S1), and a copy of two (2) deficiencies cited, facilities' appeal rights and this Facility Evaluation Report was provided to staff one, Tina Cinco (S1) - Licensee.the state’s words, verbatim · CDSS document, Jul 18, 2025

Type of visit: Required - 1 Year

On 5/10/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required using the CARE Inspection Tool. LPA met with Jeno Benosa /House Manager. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) elderly adults ages 60 and above of which (6) can be non-ambulatory, of which (1) may be bedridden in bedroom #1 or #2. Facility has an approved hospice waiver for (3). The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes along the west side of the facility. It consists of (6) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room and attached garage. LPA Iniguez toured the physical plant with Administrator. There were no bodies of water or obstructions on the premises. A total of (6) bedrooms and (2) bathrooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide are all operable conditions. The water temperature ranged from 108.5F° – 115.2F°. The room temperature ranged from 76F° – 78F°. Evaluation Report continues on LIC 809-C LPA Iniguez observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed. Cleaning supplies, toxins, and sharps objects were stored and not accessible to residents in care. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. The last Fire/Disaster Drills were conducted on 4/5/24. A review of (3) residents' service files and (3) staff personnel files were maintained in order. LPA reviewed (3) Medication Administration Records (MARs) no discrepancies were found. LPA observed the facility's infection control practices. All mandated inspection control posters were posted throughout the facility. Copy of liability insurance was provided to LPA during the visit. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Jeno Benosa /House Manager.the state’s words, verbatim · CDSS document, May 10, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual required visit and an infection control inspection to the above facility. LPA was met by Jeno Benosa House Mgr. the purpose of today’s visit was explained.There are currently (6) residents in the facility. (3) residents are ambulatory and (3) are non-ambulatory. The facility is a single-story structure located in a residential neighborhood. It has a ramp that goes along the west side of the facility. It consists of (6) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room and attached garage. LPA and Jeno Benosa House Mgr toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. INFECTIOUS CONTROL PRACTICES - LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked sanitizer/soap and paper towels in all the bathrooms and additional sanitation supplies are stored in hall closet and garage. LPA observed staff wearing masks, Residents private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and in binder, infectious Control Plan posted and/or in folder, Emergency infectious Plan posted and/or in folder, and required postings throughout the facility. Visitor designated area is located outside, resident temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPEs are enough for 30 days. All resident's and staff are vaccinated and boosted. OPERATIONAL REQUIREMENT - Fire clearances are incompliance. PHYSICAL PLANT ENVIRONMENTAL SAFETY - Bedrooms are occupied by residents and contain the mandated furniture. there are 2 staff bedroom. Bathrooms have nonskid mats, bars, and are clean and operational. (1) fire extinguishers are fully charged facility also has a fire bell pull station. First Aid kit complete with manual. The water temperature is at 115 degrees Fahrenheit. Linens and personal hygiene supplies are adequate. A comfortable temperature is maintained in the facility. Smoke detectors and carbon monoxide detectors are complying and operational. hazardous toxins and/or items are inaccessible to residents. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. LPA could complete the annual inspection and all domains.. Exit, walkways and/or passageways, front yard and back yard are free of debris and/or hazards. The facility is in good repair. STAFFING AND PERSONNEL RECORD TRAINING - 4 staff files are current with valid CPR cards, egress system operational, no volunteers at the facility. RESIDENTS REC - INCIDENT REPORT- 4 Resident files are current along with medications. RESIDENT'S RIGHTS - Internet access along with computer, visitor policy posted, PUB 475 posted. PLANNED ACTIVITIES - shaded area, indoor and outdoor activity area. FOOD SERVICE - Ample supply of perishable and nonperishable food and menu posted. INCIDENTAL M&D – The MARS is updated and complete. Resident’s medications are being given as prescribed by their physician. DISASTER PREPAREDNESS – The facility has an emergency and disaster plan, staff knows were shut off valves are located, flashlights available along with batteries, cell phones, additional emergency provisions, and conducted fire drill in April 2023. RESIDENT'S W/SHN - Some residents within facility require postural support, no residents use oxygen at this time According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time An exit interview was conducted with Jeno Benosa House Mgr. a hard copy of report was provided.the state’s words, verbatim · CDSS document, Oct 22, 2023