Tessa's Place 3

Type of visit: Required - 1 Year

On January 21, 2026, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted the facility administrator (AD) Mark Ryan Cruz about the visit. For this visit, there are four staff members on duty, all of which are background cleared and associated. AD later arrived to assist with the inspection. The PUB475 ‘See Something, Say Something’ poster was observed to be located by the front entrance. LPA observed the Administrator's Certificate for Mark Ryan Cruz, expiring on December 2, 2026. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, and a hospice waiver for six. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of six non-ambulatory residents in care, one of which is on hospice, and none are bedridden. The facility is a single story home. There are a total of five bedrooms, two of which are private resident bedrooms, two are shared resident bedrooms, and one is a staff bedroom. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff room is kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of three full bathrooms. Continued on LIC 809-C. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathrooms were measured to be between 106.1 and 111.9 degrees Fahrenheit. Facility met the minimum two day perishable and seven day non-perishable food supplies. Sharp items and knives were locked in a kitchen drawer and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the living room. Fire extinguisher was dated and tagged on March 5, 2025. LPA observed the emergency disaster and evacuation plan, which is posted in the dining room. LPA observed the facility conducted their last emergency disaster drill on December 25, 2025. Facility had back-up emergency food and water supply, located in the garage and the medication cabinet. LPA observed that the First Aid kit had all the required components. Medications were observed to be locked in a medication cabinet in the living room, inaccessible to residents in care. Chemicals were observed to be locked in the garage. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. There is an alarm on the garage door as well. The garage is used for storage and laundry. For the exterior portion, LPA observed patio furniture under shading, and the grounds were free of any hazards or obstructions. There is one self-latching gate in the backyard that can be opened in case of an emergency. No bodies of water were observed. During this visit, six resident files and four staff files were reviewed. All staff are background cleared and associated with the facility. LPA reviewed residents’ medication and medication records and one resident and one staff interview were conducted. Based on today's observations, there are no deficiencies being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Mark Ryan Cruz. This report was reviewed with the administrator and a copy was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 8am. During today’s visit, LPA met with Justin Cruz, Office Manager and .Mark Cruz, Administrator (AD). The facility is a single story residential home with four resident rooms, one staff room and an approved fire clearance of six non-ambulatory residents; of which six may be on hospice. The facility currently has a census of six residents in care and three receiving hospice services. Residents were observed eating breakfast in the dining room. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits, The hot water temperature measured between 105.9 and 109.5 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. The fire extinguisher is charged and was serviced on March 5, 2024. The facility’s last fire drill was conducted on November 30, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA also observed the First Aid Kit had the required elements and a First Aid book. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a pending renewal administrator certificate which expires on December 2, 2026.. (Continued on LIC 809-C) (Continued from LIC 809) Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Mark Cruz, Administrator (AD) and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Jan 10, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on citations issued on 10/07/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. Licensee replaced flooring. Licensee has complied with the POC. Licensee has been advised to maintain compliance in all items previously cited. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 3, 2025

Type of visit: POC

Licensing Program Analyst (LPAs) Kimberly Lyman and Fred Arias conducted an unannounced Plan of Correction visit. Upon arrival, LPAs observed facility is tented for termites. LPA contacted Administrator by telephone to determine the situation. Administrator Mark Cruz stated facility will be tented until tomorrow, December 7, 2024 and residents had been relocated. Mark stated advising LPA Cho of the circumstances. LPA advised would follow up with visit once the extermination was completed. Report emailed to Administrator.the state’s words, verbatim · CDSS document, Dec 6, 2024

Allegation investigated: Facility is in disrepair

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to continue the investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff. Regarding the allegation that facility is in disrepair, the investigation revealed the following: During the tour of facility, LPA observed three spots where the flooring is missing or has detached from the floor. There is one spot in the entry, one in the hall and one in a resident room. The remainder of the facility physical plant appears clean, safe and sanitary. Based on observation, the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights. Substantiatedthe state’s words, verbatim · CDSS document, Oct 7, 2024 · control 22-AS-20210713124144

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 21, 2024

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 req is not being met as evidenced by: Based on observation, Licensee failed to ensure facility is in good repair. LPA observed three spots where flooring is coming up. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 7, 2024

Plan of correction: Licensee to repair/ replace noted areas and forward proof to LPA by POC due date.

Allegation investigated: Facility is in disrepair. Facility has an infestation of termites.

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced to initiate the complaint investigation into the above allegations. LPA was greeted and granted entry by Caregiver Jonnel Pelayo and stated the purpose of the visit. Administrator (Admin) Eleonor Avenado arrived on premise approximately 10:00am. Regarding the allegation, Facility is in disrepair, LPA and Admin Avenado conducted the tour of the physical plant, interviewed two staff, and reviewed/obtained copies of pertinent documentation. The investigation revealed the following: Based on observations, there are a total of four existing video surveillance cameras in the common areas previously placed by the landlord that are inactive. The kitchen cabinet with the lazy susan was in working condition. The Heating, Ventilation, and Air Conditioning (HVAC) was maintained by the licensee on December 29, 2024. LPA tested the AC/Heating unit which was also observed to be in operable condition. Per review of the evidence, the facility did their due diligence by addressing the maintenance issues Unsubstantiated (such as the chipped wood floor, hole/cracks in the ceiling, and the exposed wood to the back of the property) to the landlord which had allegedly preexisted upon taking over of the facility effective January 26, 2021. Per review of the lease agreement signed on September 30, 2020, the lease agreement did not evidence clearly the chain of liability for the damage. In addition, it is documented on page 3 of the lease agreement that the tenant shall not make any repairs, alterations, or improvements without the landlord's prior written consent. The interviews also revealed that two out of the two staff attesting that the damages previously mentioned above existed prior to licensure. Regarding the allegation, Facility has an infestation of termites, LPA and the Admin did not observe signs of termite infestation and droppings during the inspection. Facility provided evidence of the last termite intervention serviced by the pest control company on February 28, 2024. Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Facility is in disrepair and Facility has an infestation of termites are deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Eleonor Avenado, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Mar 12, 2024 · control 22-AS-20240311115100

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 15, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary...for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on observation, LPA and Admin observed the ring of rust surrounding the dishwasher air gap and the silicone seal around the sink turned into black mold which poses a potential Health risk to persons in care.the state’s words, verbatim · CDSS document, Mar 12, 2024

Plan of correction: Adminstrator stated that the she will deep clean and reseal the caulk in the sink by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to conduct the Required 1-Year Annual Inspection. LPA was greeted and granted entry after stating the purpose of the visit to Caregiver Maryrose Sagum. Administrator (Admin) Mark Cruz and Office Manager Justin Cruz arrived shortly after to assist with the inspection. LPA conducted a tour of the physical plant accompanied by Caregiver Sagum and Admin Cruz. The following were observed: This is a single story facility comprised of four resident bedrooms and three resident bathrooms, laundry room/2-car garage, living/family room, and dining room. LPA toured the outside grounds. There was shading and sufficient seating for the residents. The exit gate was self-closing and self-latching. LPA observed four residents and three caregivers on duty. The resident bedrooms are spacious and easily accommodates the residents' furnishings. Furniture for each resident bedrooms were inspected. The bathrooms were clean, faucets, toilets, and grab bars were operational. The hot water temperature measured at 118.5, 118.2, and 116.6 degrees Fahrenheit. There were sufficient supply of clean linens. LPA observed a two-day supply of perishables and a seven-day supply of non-perishable food as required per regulation. Carbon monoxide, smoke detectors, and the auditory devices were tested and operational. The fire extinguisher was serviced on 03/21/23. Medications, sharps, and toxins were locked and inaccessible to the residents. Facility had ample supply of emergency supplies including food/water and first aid kit. LPA reviewed four out of the four resident files and two out of the two staff files including resident medications. Administrator was reminded on the following items: to conduct quarterly emergency drills of different variations, to accurately document when the medication was refused on the Medication Administration Record (MAR), and to dispense the medications matching the corresponding calendar date. Based on the observations made during today's visit, no deficiency is being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations. Advisory Notes (LIC9102s) are being issued during the visit. An exit interview was conducted with Administrator Mark Cruz and Office Manager Justin Cruz, and a copy of this report including the LIC809C, and the LIC9102s were provided at the end of this visit.the state’s words, verbatim · CDSS document, Feb 15, 2024