Toluca Lake Manor Senior Assisted Living II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian conduct a required annual visit today at this location. LPA Chochian was greeted by the Licensee/Administrator Mariana Romano. Introductions conducted and reason for the visit was stated. At approximately 10a.m., the LPA and Administrator toured the physical plant areas inside, and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 75 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 12/06/2025. The LPA observed required postings throughout the common space. KITCHEN: Kitchen appliances were found to be in operable condition. The emergency non-perishable food for residents and staff was found to be sufficient. The two-day perishable and seven-day non-perishable food supply was found to be sufficient for the current census of the facility. Kitchen knives observed stored and locked in a kitchen drawer. BEDROOMS: There are total of seven (7) bedrooms. One bedroom is designated for staff. There are six (6) residents’ bedrooms currently occupied as single occupancy. Bedrooms were supplied with sufficient bedding and linens, and there were no visible hazards. Lighting and room temperature were found to be appropriate. There is a linen closet in the hallway with extra towels and linens. BATHROOMS: There are six (6) bathrooms. Each bedroom has a bathroom. The bathrooms were found to have personal grooming, hygiene and sanitary supplies. Hot water temperature measured over the regulation limits at 10:36am, 12:50pm and 3:20pm (131.9*f - 136*f) in rooms #4, #5, #6. (Continue to LIC809c) OUTDOOR AREA: The property is fenced. The large water fountain in the front courtyard area observed filled with stones so that the water is leveled with the stones in the fountain. Patio furniture in the backyard in shaded area observed available for resident's use. RECORDS: Records review began at approximately 11 a.m. Residents’ records were reviewed for, but not limited to care plans, physician record, admission agreement, personal rights and consent forms. At approximately 12:30p.m. personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Records maintained current with required documents. Last disaster drills conducted on 12/03/2025. First aid kit observed complete; first aid manual/guide included. MEDICATIONS: Medications review began at 1:15p.m.; medications are centrally stored and locked in a cabinet in the kitchen; medications are labeled and checked for expiration dates. LPA reviewed five (5) residents medication and medication records. Medication procedures are followed accordingly. Minor technical documentation error noted with the start date recorded on the centrally stored medication record; start date was preset by pharmacy however medication was sent later in the evening. Staff corrected the start date to reflect correct date medication was punch out of the bubble pack. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. Discussion held with Licensee/Administrator to ensure submission of required documents: (Copy of the following documents were requested to be sent to CCLD: - LIC500 Personnel Report/schedule - Copy of the liability insurance renewal - Infection Control and Emergency and Disaster Plan Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited, (refer to LICs 809-D). Exit interview conducted; appeal rights discussed and copy of report provided.the state’s words, verbatim · CDSS document, Feb 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian conduct a required annual vist today at this location. LPA Urena was greeted by staff and the Administrator Mariana Romano. Introductions conducted and reason for the visit was explained. At approximately 10:45 a.m., the LPA and Administrator toured the physical plant areas inside, and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 74 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 01/27/2025. The LPA observed required postings throughout the common space. KITCHEN: Kitchen appliances were found to be in operable condition. The emergency non-perishable food for residents and staff was found to be sufficient. The fresh food supply was found to be appropriate for the residents currently residing at the facility. Kitchen knives are stored and locked in a kitchen drawer. BEDROOMS: There are six (6) residents’ bedrooms currently occupied as single occupancy. Bedrooms were supplied with sufficient bedding and linens, and there were no visible hazards. Lighting and room temperature were found to be appropriate. There was a linen closet in the hallway with extra towels and linens. There at total of seven (7) bedrooms. One bedroom is designated for staff. BATHROOMS: There are six (6) bathrooms. Each bedroom has a bathroom. The bathrooms were found to have personal grooming, hygiene and sanitary supplies. Hot water temperature measured within the regulation limits (112*f). OUTDOOR AREA: The property is fenced. The LPA and Administrator observed a large water fountain in the front courtyard area with running water; the water fountain is filled with stones so that the water is leveled with the stones in the fountain. Patio furniture in the backyard; shaded area available for resident's comfort. RECORDS: Records review began at 11:45 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All residents’ Appraisal and Needs and services plan was missing resident/responsible person signature. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Last disaster drills conducted in 12/2024. First aid kit observed complete; first aid manual/guide included. MEDICATIONS: Medications review began at 3p.m.; medications are centrally stored and locked in a cabinet in the kitchen; medications are labeled and checked for expiration dates. Following error observed during the medication review: No physician prescription orders for OTC medications and vitamins for two (2) out of four (4) residents medications reviewed. PRN authorization letter not on file for three (3) residents with PRN medications. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. Copy of the following documents were requested to be sent to CCLD: - LIC500 Personnel Report/schedule - Copy of the liability insurance renewal Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited, (refer to LICs 809-D). Exit interview conducted; appeal rights discussed and copy of report provided.the state’s words, verbatim · CDSS document, Feb 25, 2025

The state marks this report as 9 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) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection at 10:00 a.m. LPA Urena was greeted by staff. The Administrator Mariana Romano, arrived shortly thereafter and was explained the reason for the visit. At 10:30 a.m., the LPA and Administrator toured the physical plant areas inside, and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 74 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 04/27/2023. The LPA observed required postings throughout the common space. KITCHEN: Kitchen appliances were found to be in operable condition. The emergency non-perishable food for six residents and two staff was found to be sufficient. The fresh food supply was found to be appropriate for the six residents currently residing at the facility. Kitchen knives are stored and locked in a kitchen drawer. The two (2) fire extinguishers were fully charged and were last serviced 04/27/2023. BEDROOMS: There are six (6) residents’ bedrooms currently occupied as single occupancy. Bedrooms were supplied with sufficient bedding and linens, and there were no visible hazards. Lighting and room temperature were found to be appropriate. There was a linen closet in the hallway with extra towels and linens. There at total of seven (7) bedrooms. One bedroom is designated for staff. Staff’s bedroom door was locked at the time of the visit. See LIC 809C... BATHROOMS: There are six (6) bathrooms. Each bedroom has a bathroom. The bathrooms were found to have hand washing signs, personal grooming supplies, and paper towels. The hot water temperature measured within the regulation limits. OUTDOOR AREA: The property is fenced. The LPA and Administrator observed a large water fountain in the front courtyard area with running water, however the water fountain is filled with stones so that the water is leveled with the stones in the fountain. There is furniture appropriate for outdoor use, and shade available for residents’ use. RECORDS: Records review began at 1:00 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Two out of six residents’ files were missing/or were incomplete required forms: Admission Agreement, Physician’s Report, Personal Rights, etc. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Two out of two personnel records were missing staff signatures (LIC 501), Health Screening (LIC 503) needs to be filled out by doctor. MEDICATIONS: Medications review began at 1:39 p.m.; medications are centrally stored and locked in a cabinet in the kitchen; medications are labeled and checked for expiration dates. Medications were not properly documented on the centrally stored medications and destruction record (LIC 622). The LPA observed during the medication review the following errors: For two out of six residents, the prescription medication packet did not match the LIC 622. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster Exit interview conducted. A copy of the report and Appeal rights was issued.the state’s words, verbatim · CDSS document, Jan 30, 2024