The Maple House

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Anshu Gupta. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA observed that the exterior side exits have an auditory alarm that functioned properly when tested by the ADM. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature at 40 F and Freezer at 0 F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by staff. Fire extinguishers were last serviced on 3/2/2026. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was conducted on 6/22/2026. Page 1 of 2 LPA toured 5 resident bedrooms. All 5 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA toured 5 resident bathrooms. All 5 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature in 5 resident bathrooms with a range of 105 F to 107.2 F. LPA reviewed 3 resident records. LPA reviewed 3 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 3 staff records. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator (ADM) Anshu Gupta and a signed copy of this report was provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Aug 20, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Rose Anne Roxas. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the 4 refrigerator temperatures at 37 F and Freezer at -10 F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. The facility had a fire inspection on 4/4/2025 by a third party vendor. Fire extinguishers were last serviced on 3/11/2025. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was on 6/20/2025. Page 1 of 2. LPA toured 11 resident bedrooms. All 11 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA toured 7 resident bathrooms. All 7 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature in 7 resident bathrooms with a range of 105 F to 110.8 F. LPA reviewed 3 resident records. LPAs reviewed 3 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPAs reviewed 3 staff records. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator Rose Anne Roxas and a signed copy of this report was provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Aug 27, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced pre-licensing inspection visit and met with Administrator (ADM) Ronnie Lising. LPA observed 4 staff and 13 residents in the facility. LPA toured the facility inside out with ADM. Personal Rights posters and Administrator Certificate were observed in the facility. Living room, dining room, kitchen, 11 resident bedrooms, 8 restrooms, 2 common bathrooms, two storage rooms, laundry room, sun room, and 1 office were inspected. Two day perishable food supplies and Seven day nonperishable food supplies were observed sufficient. The temperature of the refrigerator is at 40 degree F and the temperature of the freezer is at 0 degree F. Room temperature was observed at 73 degree F. Hot water temperature was observed at 109 degree F. All the bedrooms were observed with window screens. Fire extinguisher was serviced on 05/128/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Emergency light system was observed in the facility. Call button system was observed in the facility, and was tested by ADM and was working fine. Medications closet was observed locked. Knives closet and detergent closet were observed locked. Night lights were observed at the hallway. First aid box and flash lights were observed in the facility. Bars and non skid mats were observed in the restrooms and common bathrooms. Door alarm was observed at the entrance door. LPA toured the backyard with ADM. Three storage rooms were observed at the backyard. two gate alarms were observed at the two exit gates. No obstruction were observed to block the walkway. Component II was conducted with ADM.No deficiency noted today. Exit interview was conducted with ADM. The report was provided to ADM for signatures. a copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Aug 7, 2024