The Signature Residence

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. The facility is licensed for 6 non ambulatory residents of which 1 may be bedridden. The facility has a hospice waiver for 3 residents. This is a single story home with an attached garage. The facility has 5 bedrooms with 3.5 bathrooms. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in the bathrooms. The hot water temperature measured 109.2 and 112.4 degrees Fahrenheit and all smoke detectors were operational. The facility conducted an emergency drill on 09/01/2025. 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 additional freezer and refrigerator in garage with ample food. LPA observed secured medication storage in a secured in laundry room. LPA observed emergency food and water in facility garage. LPA reviewed two out of two staff training and fingerprint records and conducted a complete review of 6 out of 6 residents files. Administrator has a current administrator certificate which expires on 04/11/2026. No deficiencies noted. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 2, 2025

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. During today’s visit, LPA met with Kolaleh Farris, Administrator. The facility is a single-story home with five bedrooms and three resident bathrooms with an approved fire clearance for six non-ambulatory residents of which one may be bedridden and three are approved for hospice. The facility currently has a census of six residents in care with one resident on hospice. 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 three of three resident bathrooms, and testing auditory devices on all exits. LPA observed shaded seating areas in the patio with an enclosed coop for chickens The hot water temperature measured between 113.0 and 119.3 degrees Fahrenheit and the centralized smoke and carbon monoxide detectors were operational. The fire extinguisher is charged and was serviced on August 2, 2024. The facility’s last fire drill was conducted in September 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. The First Aid kit had the required items and the facility has 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 current administrator certificate which expires on April 11, 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 Kolaleh "Koli" Farris, Administrator 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, Dec 9, 2024