Tessa's Place 4

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Tessa's Place 4. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 4 residents with 1 on hospice care. Administrator Mark Cruz has a current administrator certificate expiring on 12/02/2026. Administrator Mark Cruz arrived during the visit. LPA Lyman along with Caregiver Manalili toured the facility at 10:47 AM. LPA toured the physical plant, checked food service, reviewed records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, three resident restrooms, common restroom, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with half rails. Staff room is locked and inaccessible to residents in care. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.8 and 109.9 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors as well as a first aid manual. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen cabinet. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating for residents. Exit gates are unlocked. CONT ON LIC 809C DATED 04/10/2026 LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan and infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 01/29/2026. Facility provides activities in the form of exercise and games. LPA reviewed four resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals and physician orders for bed rails as indicated. Staff files contained required documentation such as health assessments/ TB, required annual training and CPR/ First aid. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly. Facility uses a medication administration record and documents routine and PRN medication administration. Medications appear to be administered per physician order. Based on the observations made during today's visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Apr 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Tessa's Place 4. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents with 4 on hospice care. Administrator Daryll Avenado has a current administrator certificate expiring on 03/28/2026. Administrator Mark Cruz arrived during the visit. LPA Lyman along with Administrator Cruz toured the facility at 11:03 AM. LPA toured the physical plant, checked food service, reviewed records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, three resident restrooms, common restroom, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with full rails and one resident with half rails. Staff room is locked and inaccessible to residents in care. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 107.7 and 113.9 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors as well as a first aid manual. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen cabinet. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating for residents. Exit gates are unlocked. CONT ON LIC 809C DATED 04/17/2025 LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan and infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 02/24/2025. Facility provides activities in the form of exercise and games. At 11:35 AM, LPA reviewed five resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports and resident appraisals and physician orders for bed rails as indicated. Staff files contained required documentation such as health assessments/ TB, required annual training and CPR/ First aid. At 12:45 PM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly. Facility uses a medication administration record and documents routine and PRN medication administration. Medications are being administered per physician order. Based on the observations made during today's visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Apr 17, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 07/18/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit. Administrator Mark Ryan Cruz and Office Manager Justin Cruz arrived during the visit. Deficiency cited under Title 22 Regulation 87303(e)(2) pertaining to Water Temperature has been cleared. During today's visit, water temperature is within regulation parameters. Licensee has complied with the POC. Deficiency cited under Title 22 Regulation 87608(a)(1) pertaining to Maintenance and Operation has been cleared. During today's visit, Kitchen has been cleaned. Licensee has complied with the POC. Licensee has been advised to maintain compliance in all items cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 22, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Rowena Manalili, Co-Administrator Mark Cruz and House Manager Justin Cruz arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory. LPA toured the interior and exterior of the facility and inspected each room. The kitchen had dirty floors, sticky and disorderly cabinets. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. One resident bedroom had a stand alone air conditioner that was collecting condensation water into a bucket, such bucket was almost full and sitting in residents room. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pool or body of water was present. Water temperature was measured at 105.3 degrees F in the kitchen and 89 degrees F in resident bathroom. Per Mark, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present. First aid kit was complete. Resident records reviewed had required documentation. Needs and Services plans were not signed by resident or responsible party. Hospice resident full bed rail orders were observed. Staff records reviewed contained required documentation. One technical violations was issued for unsigned Needs and Services Plans, three additional deficiencies were cited for physical plant. An exit interview was conducted with Co-Administrator, to whom a copy of this report, LIC9099D (x2) and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jul 18, 2024