The Leaning Pine

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA arrived unannounced and met with staff Raquel Salen. The purpose of the visit was explained. The facility is approved to serve (6) non-ambulatory residents, ages 60 and over, and (1) may be bedridden. The bedridden fire clearance is approved for bedroom #1 only. There is a hospice waiver approved for (6) residents. LPA toured the facility, reviewed documents and medications, and conducted interviews. The facility is a single story home with (4) resident bedrooms, (1) staff room, 2 bathrooms, living room with dining area, a den, kitchen, laundry area, and attached garage. The facility has an operable carbon monoxide detector and smoke detectors throughout the home. The outdoor has a shaded area with table and chairs. The fireplace is adequately screened. Knives and cleaning solutions are stored in the kitchen and inaccessible to residents. Sufficient food supplies of 2-day perishable and a week of non-perishable items are observed. Facility has sufficient space to accommodate indoor and outdoor activities. The hot water temperature in the bathroom and kitchen was measured over 120 degrees F today. LPA reviewed (5) resident files. Medications are centrally stored and locked. Facility uses the Medication Administration Record (MAR) log to document medications given and they being given as prescribed. LPA provided a technical violation for resident reappraisals to be updated at least once every 12 months. LPA reviewed (3) Staff files. The administrator's (Elna Villaflor) certificate expires on 6/5/28. Staff have current CPR & First Aid certificates and receiving annual training. The Emergency Disaster Plan is being reviewed annually and disaster drills are being conducted at least quarterly. A deficiency was issued today. An exit interview was held. A copy of this report and appeal rights were given to Staff Z. Uy.the state’s words, verbatim · CDSS document, Aug 11, 2026

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: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent Required-1 year visit. LPA was met by Raquel Salen and Lucia Ramos, Care Staff and explained the purpose of the visit. Shortly after, Administrator Elna Villaflor arrived and assisted LPA. LPA continued to utilize the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Staffing: A total of seven (7) staff members including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records/Staff Training: Administrator's proof of health clearance, fingerprint clearance, vaccinations and 1st Aid/CPR training are current. Administrator's certificate is valid and expires on 06/05/2026. Resident Rights-Information: Resident personal rights are posted. Physician orders for use of full and half bed rails were reviewed in the resident files. Facility provides internet services to all residents and have access to the facility phone. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Incidental Medical Services: Medications reviewed for all (5) residents. Residents have Restricted Health Care Plan and Needs and Services Plan on file. Currently, (4) residents under hospice care receive Home Health care in the facility. Residents medication are centrally stored in a locked cabinet next to the kitchen area. Resident Records-Incident Reports: Five (5) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records, Restricted Health Care Plans and Hospice Notes/Records were reviewed. During medication review, LPA observed the staff failed to sign the Medication Administration Record (MAR) for the a.m. medications administered on the correct date (09/16/2025)for all (5) residents. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. The facility conducts emergency drill on a quarterly basis. Last fire drill was conducted on 09/05/2025. Residents with SHN: Four (4) residents receive hospice care. Appraisals were observed in resident files. Information regarding Dementia is part of the training for direct care staff. Deficiency cited, Technical Assistance and Technical Violation issued. Exit interview and a copy of this report along with the appeal rights were provided to the Administrator, Elna Villaflor.the state’s words, verbatim · CDSS document, Sep 16, 2025

The state marks this report as 6 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) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by Raquel Salen and Zenaida Gomez, Care Staff and explained the purpose of the visit. At 2:20pm, Administrator Elna Villaflor arrived and assisted LPA. The facility is licensed to care for (6) non ambulatory residents ages 60 and above and one may be bedridden. Bedridden fire clearance approved for bedroom #1 only. Approved to care for (6) hospice residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Staff are using appropriate hand hygiene and wearing gloves while assisting residents. Operational Requirements: A fire clearance is in place. Facility has working signal systems in exit points. Liability Insurance policy is valid and will expire on 04/02/2026. LPA observed that the fire extinguisher in the kitchen was not secured/mounted on the wall as required. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that consists of (4) resident bedrooms, (1) staff bedroom, (2) bathrooms, living room with a covered fireplace, kitchen, dining area, den, laundry area in the hallway, backyard with shaded patio area and attached garage. Currently, there are five (5) residents in the facility. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. Backyard was inspected and has a shaded area and sitting area. There is (1) fire extinguisher in the facility which was last serviced on 07/10/2025. There is a carbon monoxide detector in the hallway and smoke detectors are interconnected. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. *****REPORT CONTINUED ON LIC809-C**** Residents with SHN: LPA observed an unsecured oxygen tank lying on the floor in the attached garage. Due to time constraints, LPA has to continue the annual inspection at a later date. LPA has to complete the following domains: Staffing, Personnel Records/Staff Training, Resident Rights-Information, Planned Activities, Food Service, Incidental Medical Services, Resident Records-Incident Reports, Disaster Preparedness and Residents with SHN. Technical Violation and Technical Assistance were issued. Exit interview conducted and a copy of this report was provided to the Administrator, Elna Villaflor.the state’s words, verbatim · CDSS document, Sep 11, 2025

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility did not have staff screened for Tuberculosis.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced and met with Administrator, Elna Villaflor. The reason for the visit was explained. During the visit today, LPA toured the facility and obtained copies of the client and staff rosters. LPA also reviewed personnel files and interviewed the administrator, 2 Staff, and 2 Residents. Allegation - Facility did not have staff screened for Tuberculosis. It is alleged that a volunteer and another staff did not have a TB clearance or receive TB testing. LPA interviewed the administrator and two Staff. Administrator Villaflor stated that the volunteer in question only worked briefly at their other facility, named Banner Ridge Country Home, sometime in November of 2024, but not at this facility. She stated that all the staff are required to have a health screening and TB testing when they are hired. Unsubstantiated LPA interviewed two other staff, and both stated they had gotten a health screening and TB test results when they were hired at the facility. One of the staff and residents interviewed confirmed the volunteer in question did not work at the facility. LPA reviewed current personnel files and observed TB test results and/or chest x-ray at the time of hire. Based on the information gathered, there is insufficient evidence to prove this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with the administrator. A copy of this report, along with the appeal rights, was provided.the state’s words, verbatim · CDSS document, Apr 25, 2025 · control 28-AS-20250421114238

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 8/23/24 using the Compliance and Regulatory Enforcement (CARE) tools. LPA arrived unannounced and met with the co-administrator, Zenaida Uy. The purpose of the visit was explained. Administrator, Elna Villaflor, arrived later to assist with the visit. The facility is licensed to serve (6) non-ambulatory residents, ages 60 and over, of which (1) may be bedridden. The bedridden fire clearance is approved for bedroom #1 only. The facility is approved to care for (6) hospice residents. The facility is a single story home that consists of 4 resident bedrooms, 1 staff bedroom, 2 bathrooms, living room, dining area, a den, kitchen, and attached garage. The outdoor has a shaded area with table and chairs. There are no items obstructing the walkway. The fireplace is adequately screened. Knives, disinfectants, and cleaning solutions are stored in the kitchen and inaccessible to residents. The kitchen area is clean and free of insects/vermin. No swimming pool or bodies of water on the premises. There is a carbon monoxide detector in the hallway and smoke detectors are interconnected. Staff are continuing to clean and disinfect the home. They are using appropriate hand hygiene and wearing gloves while assisting residents. There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The foods are properly stored in the refrigerator. Facility has sufficient space to accommodate indoor and outdoor activities. LPA reviewed all 5 resident files and they have the required documents. Medications are centrally stored and locked. Facility uses the Medication Administration Record (MAR) log to document medications given and no discrepancies were found. LPA reviewed 3 Staff files. The administrator's (Elna Villaflor) certificate expired on 6/5/24, however, it has been verified the renewal documents were received and is pending review by the Administrator Certification Bureau. Staff have current CPR & First Aid certificates and receiving on-going training. The facility has the adequate amount of liability insurance. No deficiencies were issued today. LPA provided technical assistance on the Emergency Disaster Plan. An exit interview was held and a copy of this report was given to Z. Uy.the state’s words, verbatim · CDSS document, Aug 23, 2024

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.