The Retreat at Las Palmas

Type of visit: Required - 1 Year

On May 29, 2026, at 12:30 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Michelle Otbo and explained the purpose of the visit. Administrator Michelle Otbo stated she could not stay for the visit and Staff Ines Otbo could sign on behalf of the facility. The facility is licensed to have a capacity of six (6) nonambulatory and a hospice waiver for six (6) residents. LPA Kim observed the following. The facility is a one-story house with an attached 2-car garage with four (4) resident bedrooms, one staff bedroom, three bathrooms, family room, dining room, a kitchen, a living room, and two outdoor shaded areas. LPA Kim toured inside and outside of the physical plant. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 115.7 degrees F and 116.2 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water and emergency supplies are stored in the garage and in the staff room closet. All mandated inspection control posters were posted. The facility has smoke detectors and carbon monoxide detectors that were operable. The Certificate of Liability Insurance is effective from July 11, 2025 to July 11, 2026. The facility conducts Fire/Safety Drills quarterly and was last conducted on March 26, 2026. Four (4) fire extinguishers were mounted in the kitchen, garage, family room, and in the laundry room.. A working telephone Facility phone number (657-248-7381). and tablet device dedicated to the residents both remain available. First Aid Kit contained all the necessary elements. LPA Kim conducted an audit of three (3) residents (R1-R3) files, five (5) staff (S1-S5) personnel files, and medication and medication records that all were complete and all in order. LPA conducted interviews for two (2) residents and three (3) staff. No deficiencies were cited for today’s inspection visit. An exit interview was conducted, and a copy of this report was provided to Staff Ines Otbo.the state’s words, verbatim · CDSS document, May 29, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Edward Kim made an announced visit to conduct the subsequent pre-licensing inspection. LPA Kim was greeted and granted entry by Applicant Michelle Otbo. LPA Kim explained the reason for the visit upon entry. The first pre-licensing inspection was made on March 19, 2025 and several corrections were needed. During a tour of the facility, LPA Kim observed that the following items have been corrected: 1) A video conference internet tablet dedicated to the residents was operational and available for use. 2) Monthly inspection tags were on Fire extinguishers. 3) Applicant states the nook will not be made into a bedroom for residents or staff. The nook will be utilized for residents as an activity area or for visitors for a private space with the residents they are meeting up with. All items have been corrected. No new deficiencies were observed. The facility is ready for licensure. The pre-licensing visit and Component III Orientation are now complete. This facility meets the requirements for licensure. LPA Kim will forward this report to the Centralized Applications Bureau for review. The license will be granted upon completion of a final review and approval from the Centralized Applications Bureau. An exit interview was conducted and a copy of this report was provided to applicant Michelle Otbo.the state’s words, verbatim · CDSS document, Jun 20, 2025

Type of visit: Prelicensing

On March 19, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Kim met with Applicant Michelle Otbo and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to CCL on December 5, 2024. The facility is to have a capacity of six (6) nonambulatory. Applicant has requested a hospice waiver for six (6) residents. Facility phone number (657-248-7381). LPA Kim observed the following. Structure: The facility is a one-story house with an attached 2 car garage with five (5) resident bedrooms, one (1) caregiver bedroom but facility sketch shows it as a nook, three (3) bathrooms, family room, dining room, a kitchen, and a living room. There are eight (8) exits: one exit door in the family room, one in the main entrance, an exit next to the bathroom and laundry room, one in bedroom #1, one in bedroom #2, one in bedroom #3, one in bedroom #4, and one in bedroom #5. Air/Heating: Central air/heating system installed with a central panel to control entire house located in the hallway. The house temperature is at 72 degrees Fahrenheit. Resident Bedrooms: There are five (5) Resident Bedrooms: Bedroom #1, Bedroom #2, Bedroom #3, Bedroom #4, and Bedroom #5. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings. Evaluation Report Continues on LIC 809-C Staff Bedrooms: There is one (1) Staff Bedroom, but the facility sketch has it listed as a nook. Bathrooms: All bathrooms have a working toilet, wash basin and shower. All bathrooms are clean. Shower mats were in all three bathrooms. Hot water was measured in all bathrooms. Hot water measured between 116.9 degrees Fahrenheit to 118.7 degrees Fahrenheit. Linens & Hygiene Supplies: Adequate supply of linen stored in bathroom 2. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed and posted in the entrance hallway. Menus posted and available in the kitchen refrigerator. Food Service: There are no residents living in the facility currently. The emergency food, emergency water, and emergency supplies are stored in the garage. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There are four (4) fire extinguishers, which are mounted on the wall in the kitchen, family room, in the hallway next to the bathroom 1, and garage. The fire extinguisher is fully charged. All four fire extinguishers are missing the monthly inspection tag and were purchased on October 23, 2024, with a receipt attached on each fire extinguisher. Toxins: All cleaning supplies and chemicals are kept in the garage and locked underneath the kitchen sink. Evaluation Report Continues on LIC 809-C Outdoor/Yard: There is an outdoor covered patio area in the backyard with enough tables and chair for the residents. There is a table and two chairs in the front in a shaded area. Outdoor gate is self-closing and self-latching. There is a fountain in the backyard without standing water. There is no intention to have water in the fountain and will be used as backyard décor. Medications, First-Aid Kit & Book: The first aid kit and all medications are stored in medical cabinet, which is in the dining room. The first aid kit has all the required elements. Resident & Staff Files: The Resident and Staff Records will be kept locked in filing cabinet in the Livingroom. Reading Material, Games, Equipment & Materials: There is a large screen TV in the living room. Appliances: There is an electric stove with four burners which lights unassisted, double oven, blender, microwave oven, a refrigerator in the kitchen, dishwasher, washer, and dryer. All appliances are clean and operational. Fire clearance: Fire Clearance approved by Fullerton Fire Department on January 27, 2025. Component III: Component three will be discussed on the next visit. During the pre-licensing inspection, LPA Kim observed the following items that must be corrected:1) A video conference internet device such as a tablet, laptop, or smart phone dedicated to the residents, 2) Fire Extinguishers bought in October 23, 2024, need monthly inspection tags, and 3) A submission to CAB Pre-Licensing for the facility sketch to update the nook as a Staff Bedroom with a LIC200, old facility sketch, new facility sketch, and in writing the reason for updating the sketch. Evaluation Report Continues on LIC 809-C The applicant plans on making the necessary corrections and contacting LPA Kim to schedule a follow up pre-licensing inspection. An exit interview was conducted, and a copy of this report has been provided to Applicant Michelle Otbo. LPA Edward Kim will submit a copy of the facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application. Exit interview was conducted and a copy of this report was left with Applicant Michelle Otbothe state’s words, verbatim · CDSS document, Mar 19, 2025

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Michelle Otbo, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 5, 2025