Torrance Regency Senior Living

Type of visit: Required - 1 Year

On 04/24/2026 at 08:00 AM, Community Care Licensing Division (CCLD) conducted an unannounced annual inspection visit at the Torrance Regency Senior Living Facility. CCLD staff were allowed entry into the facility by Administrator Trish Ocampo. The facility is licensed to serve (6) non-ambulatory residents for 60 years and over of which (5) may be bedridden. Bedrooms approved for bedridden residents are rooms 2,3,4,5 and 6. Facility is approved hospice waiver for (6) residents. The facility is a single-story home located in a residential neighborhood and consists of (6) resident bedrooms, (1) staff bedroom, (1) resident bathroom, (1) private bathroom located in room #1, 1 staff bathroom, living room, dining area, staff working area, kitchen, laundry area, de- attached garage and a backyard with a shaded area. Patio chairs located in the front lawn area. Currently, there are six (6) residents residing in the facility. CCLD staff explained to Administrator Ocampo the purpose of the one-year Annual Inspection visit, and escorted CCLD staff on a tour of the entire inside and outside facility grounds. As part of the inspection, CCLD staff reviewed: Six (6) residents service records, six (6) residents medication administration records (MAR), three (3) staff records, and inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 12/02/2025. No weapons are stored on the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is in the garage and kitchen area. CCLD staff observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. CCLD staff observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, CCLD staff observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. CCLD staff observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 110 degrees Fahrenheit; bathroom #2 hot water temperature properly measured at 109 degrees Fahrenheit. Kitchen hot water temperature properly measured at 114 degrees Fahrenheit. Facility two (2), Carbon Monoxide and nine (9) Smoke Detectors hard-wired operated and connected were tested and are working properly. The facility two (2) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. The facility has a working landline telephone. All toxins and knives are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet. Facility two (2) first aid kit is fully stocked with manuals was checked and in order. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. Six (6) resident files were reviewed and found to be complete. CCLD staff reviewed six (6) resident medications (MAR) and they were all found to be administered according to doctor's orders. Three (3) staff files were checked, and they have the required documents. CCLD staff noted the Administrator Francis Liwanag Certification # 6074654740 expiration date of 01/28/2027 was valid at time of inspection. The facility does not handle residents’ money/cash resources, and no surety bond is needed. Commercial General Liability Policy #BSICDMRC010716235AL policy period from 08/16/2025 to 08/16/2026 underwritten by Benchmark Specialty Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. Administrator Liwanag to email CCLD staff a full copy of the commercial insurance policy including all endorsements no later than 05/10/2026. All the required documents are posted in the facility in a clearly visible . According to the California Code of Regulations (Title 22, Division 6, Chapter 8), CCLD staff did not observe any deficiencies therefore no citations were issued at this time. Annual Licensing Fee is CURRENT. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Trish Ocampo.the state’s words, verbatim · CDSS document, Apr 24, 2026

Allegation investigated: Staff did not allow resident to have a visit from a medical professional at the facility.

On 04/02/2026 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Torrance Regency Senior Living and was greeted by Administrator Tricia De Ocampo (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation. The investigation consisted of the following: LPA Calderon interviewed Staff S1, residents R1, witness W1. LPA Calderon obtained the following records: Physician report (dated 08/07/2025), incident report (dated 03/27/2026), Power of Attorney (dated 07/07/2023, 03/27/2026), Admission Agreement (dated 02/13/2026), preplacement (dated 02/13/2026) for R1. The investigation revealed the following: Unsubstantiated Regarding the Allegation: Staff did not allow residents to have a visit from a medical professional at the facility. This complaint alleged that the facility refused to allow home health care nurses to visit. Records review indicate the following: Physician report (dated 01/28/2026) indicates that R1 has health issues and cognitive issues. Incident report (dated 03/27/2026) indicates that R1 refused to meet with home health care nurses. Power of Attorney (dated 03/27/2026) indicates that W1 could make medical decisions for R1. Interviews indicate the following: W1 indicates that W1 was advised by staff that R1 refused to meet with home health care nurse on 03/27/2026. W1 indicates that R1 daughter did not have control of R1 medical decisions. S1 indicates that R1 refused to meet with home health care nurse on 03/27/2026 and facility staff advised W1 of R1 decision. S1 indicates that the home health care company refused to give any medical records. R1 indicates that R1 did not want to meet with home health care nurse on 03/27/2026. R1 indicates that R1 did not want to deal with R1 daughter. R1 indicates that W1 had power of attorney for R1 medical decisions. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff did not allow resident to have a visit from a medical professional at the facility” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Tricia De Ocampo (S1).the state’s words, verbatim · CDSS document, Apr 2, 2026 · control 11-AS-20260327133537

Allegation investigated: Staff do not ensure accurate resident records are maintained. Staff did not provide medical personnel with medical records in a timely manner. Staff are over medicating resident in care.

On 03/19/26 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the facility. LPA was met by Susana "Nadine" Sibiayn - Assistant Administrator (S1) and the purpose of the visit was explained. S1 and LPA toured the facility. The investigation consisted of the following: On 03/19/26 LPA requested and reviewed facility documents: Admission Agreement for R1, Preplacement Appraisal Information, Medical Assessment (LIC602A) (dated: 08/07/25), Identification and Emergency Information, Medication Administration Record (MAR) for the months of February - March 2026, two (2) Veterans Affairs (VA) Advance Directive Power of Attorney for Health Care and Living Will (dated 07/07/23 & undated) and LPA toured the facility with S1. LPA interviewed three (3) out of five (5) residents (R1-R3) and three (3) out of eight (8) staff (S1-S3). R4 and R5 were not available to be interviewed due to their current medical condition. Report continues, please see LIC9099-C. Unsubstantiated The investigation revealed the following: Regarding the allegation "Staff do not ensure accurate resident records are maintained", it is being alleged that a hospital has outdated information regarding the Power of Attorney (POA). Between 09:00AM and 12:30PM, LPA interviewed three (3) residents and three (3) staff. Record reviews revealed that there has been a change in a residents' choice of POA. However the updated POA is only valid with Veterans Affairs (VA) hospital and has not yet been notarized due to a resident's California State Identification (ID) being expired. This indicates that the updated POA paperwork is not yet valid at hospitals outside of the VA, which is where a resident was most recently taken. Interviews revealed that all three (3) clients and all three (3) staff have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation "Staff did not provide medical personnel with medical records in a timely manner.", it is being alleged that, as of 03/16/26, an updated POA has not been provided to a dialysis treatment center. Record reviews revealed that there has been a change in a residents' choice of POA. However the updated POA is only valid with Veterans Affairs (VA) hospital and has not yet been notarized due to a resident's California State Identification (ID) being expired. This indicates that the updated POA paperwork is not yet valid at hospitals outside of the VA, which is where a resident was most recently taken for dialysis treatment. Interviews revealed that all three (3) clients and all three (3) staff have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation "Staff are over medicating resident in care." Record reviews revealed that all medications being provided to a resident (R1) align with medications that have been ordered by R1's doctor and are being provided in a timely manner. Interviews revealed that all three (3) clients and all three (3) staff have denied the allegation has taken place. LPA's observation of R1's medication align with R1's MAR and there are no other medications, outside of R1's doctor's orders, being provided to R1. Based on record reviews, interviews conducted and LPA's observation, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with Susana "Nadine" Sibayan - Assistant Administrator and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Mar 19, 2026 · control 11-AS-20260316102440

Allegation investigated: Staff did not provide medical personnel with medical records in a timely manner. Staff disclosed confidential information about resident to others. Staff are not following resident's special dietary needs. Staff did not ensure resident received a copy of the admissions agreement. Staff did not ensure residents medications were accurately accounted for during admission.

On 02/03/26, LPA Gonzalez conducted an unannounced subsequent complaint visit to further investigate the allegations listed above and deliver findings. LPA was greeted by Administrator, Francis Liwanag, and explained the purpose of the visit. LPA was granted access to the facility. The investigation consisted of the following: On 11/05/25, LPA Gonzalez obtained copies of the following records: staff roster, resident roster, menu for the month of October 2025, Admission Agreement for R1, Medication/Prescription list for R1, and Special dietary information for R1. LPA conducted interviews with staff #1-#3 (S1-S3) and residents #1-#3 (R1-R3) and attempted to interview resident #4 (R4). Additionally, LPA and Tricia Deocampo toured the entire facility. On 02/03/25, LPA Gonzalez obtained a copy of R1's Needs & Services Plan. Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff did not provide medical personnel with medical records in a timely manner. It is being alleged that on 10/27/25, a doctor at UCLA Medical Center asked facility Administrator to provide medical records for R1, but no records were provided. It is also being alleged that R1’s family member contacted facility administrator multiple times to ask them to send the medical records to the doctor. On 11/05/25, LPA Gonzalez conducted interviews with staff S1-S3. Of those interviewed, 2 out of 3 staff denied the allegation, and 1 out of 3 staff could not corroborate with the allegation. An interview with S2 revealed that S2 spoke with a physician at UCLA Medical Center on 10/27/25 and verbally provided the requested information regarding R1. S2 stated that on 10/28/25, after speaking with Witness #1 (W1), who requested that R1’s medical records be sent in paper form to the physician, S2 mailed the requested medical records on 10/28/25. On 11/05/25, LPA Gonzalez conducted interviews with residents R1-R3 and attempted to interview R4 but were unable to as they were sleeping. Of those interviewed, 3 out of 3 residents could not corroborate with the allegation. Based on records reviewed, and interviews conducted, there is insufficient evidence to support the 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. Allegation: Staff disclosed confidential information about resident to others. It is being alleged that facility Administrator has been contacting R1’s responsible party’s sibling via text and phone calls about R1, despite their request that no information be shared without their consent. On 11/05/25, LPA Gonzalez conducted interviews with S1-S3. Of those interviewed, 3 out of 3 staff denied the allegation. An interview with S1 indicated that R1 maintains ongoing communication with their family and retains the right to authorize the release of personal information at their discretion. On 11/05/25, LPA Gonzalez conducted interviews with residents #1-#3 (R1-R3) and attempted to interview R4 but were unable to as they were sleeping. Of those interviewed, 3 out of 3 residents could not corroborate with the allegation. Continued on LIC9099-C Based on observation, and interviews conducted, there is insufficient evidence to support the 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. Allegation: Staff are not following resident's special dietary needs. It is being alleged that staff do not ensure R1 is provided with an adequate amount of liquids, and that staff does not ensure R1 receives food of sufficient quality. It is also being alleged that staff are not following R1’s dietary restrictions. On 11/05/25, LPA Gonzalez conducted interviews with staff S1-S3. Of those interviewed, 3 out of 3 staff denied the allegation. On 11/05/25, LPA Gonzalez conducted interviews with residents R1-R3 and attempted to interview R4 but were unable to as they were sleeping. Of those interviewed, 3 out of 3 residents denied the allegation. 3 out of 3 residents said they receive 3 meals a day, with snacks in between. 3 out of 3 residents said they are receiving good nutritious meals daily at the facility. 3 out of 3 residents said they are receiving an adequate amount of liquids daily. On 02/03/26, LPA Gonzalez conducted a review of R1’s Needs and Service Plan dated: 01/02/26. Per service plan, R1 requires a special low sodium diet. On 12/29/25 LPA conducted a tour of the kitchen facility, LPA observed all special diets, and dietary needs are printed and displayed on kitchen wall. The Kitchen staff also have a binder with all residents and their dietary needs. Based on observation, and interviews conducted, there is insufficient evidence to support the 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. Allegation: Staff did not ensure resident received a copy of the admissions agreement. It is being alleged that R1 and/or their responsible party never received a copy of the admissions agreement. On 11/05/25, LPA Gonzalez conducted interviews with staff S1-S3. Of those interviewed, 3 out of 3 staff denied the allegation. Continued on LIC9099-C On 11/05/25, LPA Gonzalez conducted interviews with residents R1-R3 and attempted to interview R4 but were unable to as they were sleeping. Of those interviewed, 3 out of 3 residents could not corroborate with the allegation. On 11/05/25, LPA Gonzalez reviewed resident service files for R1-R3 and observed that each resident received a signed and dated copy of their admission agreement. Based on observation, and interviews conducted, there is insufficient evidence to support the 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. Allegation: Staff did not ensure residents medications were accurately accounted for during admission. It is being alleged that a prescription bottle of medication was seen in a box containing R1’s belongings. It is also being alleged that staff did not account for that medication when R1 was admitted to the facility in August 2025. On 11/05/25, LPA Gonzalez conducted interviews with staff S1-S3. Of those interviewed, 3 out of 3 staff denied the allegation. An interview with S1 revealed that all prescribed resident medications are accounted for upon admission and as changes occur. On 11/05/25, LPA Gonzalez conducted interviews with residents R1-R3 and attempted to interview R4 but were unable to as they were sleeping. Of those interviewed, 3 out of 3 residents could not corroborate with the allegation. 3 out of 3 residents said they receive their medication daily, on time and as prescribed by their physician. On 11/05/25, LPA Gonzalez conducted a review of R1’s Medication Prescription List. No discrepancies were identified when compared to the medications on hand. Based on observation, and interviews conducted, there is insufficient evidence to support the 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. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 11-AS-20251030154153

Allegation investigated: Staff are not following proper procedures when lifting resident. Staff are not ensuring that resident is being provided food of sufficient quality. Staff do not ensure that resident is being provided an adequate amount of liquids. Staff do not assist resident with eating as necessary. Staff are not ensuring that resident is taking their medication(s) as Staff are not ensuring that resident has an operative wheelchair. Staff do not ensure that resident attends their medical appointments as Staff handle resident in a rough manner.

On 10/28/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Torrance Regency Senior Living was greeted by Administrator Trisha DeCampo (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: LPA Calderon interviewed Staff S1-S3, residents R1-R4. LPA Calderon obtained the following records: Medication Administration Record (MAR) for R1 (date 08/2025 to 10/2025), Incident report (dated 10/27/2025), Text messages between staff and conservatory (dated open to 2025), Preplacement Appraisal (dated 08/18/2025), Physician report (dated 08/07/2025), Menu and diabetic menu, medical records (dated 08/17/2025), Hoyer Lift training for R1. The investigation revealed the following: Unsubstantiated Regarding the Allegation: Staff do not follow proper procedures when lifting residents. This complaint alleged that the facility did not use the Hoyer lift to move residents from bed to wheelchair. LPA Calderon toured the facility with S1 and did not note any negative interaction between staff and residents. LPA Calderon noted staff giving morning medications to residents. Records review indicate the following: Hoyer Lift training was reviewed. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 was taken to the hospital on 10/27/2025 for heart issues and could not be interviewed. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff are not following proper procedures when lifting resident” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff are not ensuring that residents are being provided with food of sufficient quality. This complaint alleged that the facility staff did not provide food for residents to eat. LPA Calderon toured the facility with S1 and did not note any negative interaction between staff and residents. LPA Calderon noted weekly menu and diabetic menu for R1. LPA Calderon noted 2 days and 7-day supply of food. Records indicate the following: reviewed text messages between staff and R1 conservator. Text indicate that staff had communicated with conservator meals being provided to R1. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 was taken to the hospital on 10/27/2025 and could not be interviewed. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff are not ensuring that resident is being provided food of sufficient quality” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff do not ensure that residents are provided with an adequate amount of liquids. This complaint alleged that the facility staff did not provide liquids for residents to drink. LPA Calderon toured the facility with S1 and did not note any negative interaction between staff and residents. LPA Calderon inspected the kitchen and noted juice, water and other liquids for residents to drink. Records indicate the following: Reviewed text messages between staff and R1 conservator. Text indicate that staff had communicated with conservator regarding liquids being provided to R1. Reviewed menu for facility and liquids are offered to residents. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 was taken to the hospital due to heart issues on 10/27/2025 and could not be interviewed. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff do not ensure that resident is being provided an adequate amount of liquids” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff do not assist residents with eating as necessary. This complaint alleged that the facility staff did not help R1 eat food provided by the facility. LPA Calderon toured the facility with S1 and did not note any negative interaction between staff and residents. LPA Calderon noted staff provided food for residents. Reviewed text messages between staff and R1 conservator. Text indicate that staff had communicated with conservator regarding food being served to R1. LPA Calderon did not see any residents needing help eating food. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 was taken to the hospital due to heart issues on 10/27/2025 and could not be interviewed. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff do not assist resident with eating as necessary.” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff are not ensuring that resident is taking their medications as necessary. This complaint alleged that the facility staff did not give R1 medication. LPA Calderon toured the facility with S1. LPA Calderon noted staff providing medications to residents. Records indicate the following: LPA Calderon reviewed Medication Administration Record (MAR) for 08/2025 to 10/2025. Appears staff provided medication daily. LPA Calderon did not notice staff missing medication for R1. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 was taken to the hospital for heart issues on 10/27/2025 and could not be interviewed. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff are not ensuring that resident is taking their medications as necessary” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff are not ensuring that residents have an operative wheelchair. This complaint alleged that the R1 wheelchair does not work. LPA Calderon toured the facility with S1 and noted that R1 wheelchair was in the living room area. LPA Calderon inspected the wheelchair for R1. LPA Calderon did not see any issues with R1 wheelchair. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 was taken to the hospital for heart issues on 10/27/2025 and could not be interviewed. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff are not ensuring that resident has an operative wheelchair” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff are not ensuring that residents attend their medical appointments as necessary. This complaint alleged that the facility staff did not make doctor appointments for R1. LPA Calderon toured the facility with S1 and did not note any negative interaction between staff and residents. Records indicate the following: Reviewed text messages between staff and R1 conservator. Text indicate that staff had communicated with conservator and advised when doctors’ appointments were made and cancelled. Reviewed Incident Report (dated 10/28/2025) report indicates that R1 appointments were cancelled for various reasons and that R1 family member was advised. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 was taken to the hospital for heart issues on 10/27/2025 and could not be interviewed. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff do not ensure that resident attends their medical appointments as necessary” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff handle residents in a rough manner. This complaint alleged that the facility staff handled R1 in a rough manner when moving R1 from bed to wheelchair. LPA Calderon toured the facility with S1 and did not note any negative interaction between staff and residents. Records indicate the following: Reviewed Hoyer Lift training for staff. Interviews indicate the following: 3 out of 3 staff deny the allegation. R1 was taken to the hospital for heart issues on 10/28/2025 and could not be interviewed. 3 out of 4 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff handle resident in a rough manner” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Trisha DeCampo (S1).the state’s words, verbatim · CDSS document, Oct 28, 2025 · control 11-AS-20251021163040

Type of visit: Required - 1 Year

On 03/20/2025 at 10:30 AM, Community Care Licensing Division (CCLD) conducted an unannounced annual inspection visit at the Torrance Regency Senior Living Facility. CCLD staff was allowed entry into the facility by Administrator Jonna Lamb. Administrator Lamb asked infection control questions and took CCLD staff temperature prior to entrance into the facility. The facility is licensed to serve (6) non-ambulatory residents 60 years and over of which (5) may be bedridden. Bedrooms approved for bedridden are rooms 2,3,4,5 and 6. Facility is approved hospice waiver for (6) residents. The facility is a single-story home located in a residential neighborhood and consists of (6) resident bedrooms, (1) staff bedroom, (1) resident bathroom, (1) private bathroom located in room #1, 1 staff bathroom, living room, dining area, staff working area, kitchen, laundry area, de- attached garage and a backyard with a shaded seating area. Currently, there are six (6) residents residing in the facility. CCLD staff explained to Administrator Lamb, the purpose of the one-year Annual Inspection visit, and escorted CCLD staff on a tour of the entire inside and outside facility grounds. As part of the inspection, CCLD staff reviewed: Six (6) residents service records, six (6) residents medication administration records (MAR), three (3) staff records, and inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 03/04/2025. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is in the garage and kitchen area. CCLD staff observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. CCLD staff observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, CCLD staff observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. CCLD staff observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 113 degrees Fahrenheit; bathroom #2 hot water temperature properly measured at 111 degrees Fahrenheit. Kitchen hot water temperature properly measured at 112 degrees Fahrenheit. Facility two (2) Carbon Monoxide and nine (9) Smoke Detectors hard wired operated and connected were tested and are working properly. The facility one (1) Fire Extinguishers was checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. The facility has a working landline telephone. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet. Facility two (2) first aid kit is fully stocked with manuals was checked and in order. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. Six (6) resident files were reviewed and found to be complete. CCLD staff reviewed six (6) resident medications (MAR) and they were all found to be administered according to doctor's orders. Three (3) staff files were checked and have the required documents. CCLD staff noted the Administrator Jonna Lamb Certification # 6058068740 expiration date of 12/22/2024 was NOT valid at time of inspection. The facility does not handle residents money/cash resources, and no surety bond is needed. Commercial General Liability Policy #PCI8464378102 policy period from 08/16/2024 to 08/16/2025 underwritten by Primary Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. Administrator Lamb to email CCLD staff a full copy of the commercial insurance policy including all endorsements no later than 03/30/2025. All the required documents are posted in the facility in a clearly visible area. During the visit, CCLD staff observed the facility infection control practices. CCLD staff observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). CCLD staff observed staff and residents were NOT wearing face coverings. CCLD staff observed the facility has a 30-day supply of Personal Protective Equipment (PPE). CCLD staff reviewed LIC500, and all staff associated to facility. CCLD staff advised the Administrator Lamb to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), CCLD staff did not observe any deficiencies therefore no citations were issued at this time. Annual Licensing Fee is CURRENT. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Jonna Lamb.the state’s words, verbatim · CDSS document, Mar 20, 2025

Type of visit: Required - 1 Year

On 03/06/24 at 1:10PM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Administrator Jonna Lamb. The facility is licensed to serve (6) non-ambulatory residents 60 and over of which (5) may be bedridden. Bedrooms approved for bedridden are rooms 2,3,4,5 and 6. Facility has an approved hospice waiver for (6) residents. The facility is a single-story home located in a residential neighborhood and consists of (6) resident bedrooms, (1) staff bedroom, (1) resident bathroom, (1) private bathroom located in room #1, 1 staff bathroom, living room, dining area, staff working area, kitchen, laundry area, de- attached garage and a backyard with a shaded seating area. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 105.8F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Continue to LIC 809-C LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. Fire extinguisher, last serviced February 16, 2023 was observed. Staff tested carbon monoxide and smoke detectors located throughout the facility. Devices were functional and interconnected. 5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. Two staff interviews were conducted. 5 resident records were reviewed and, 5 out of 5 resident records had medical assessments and pre-appraisals/reappraisals. Two residents’ medication was reviewed and two residents were interviewed. No deficiencies are being cited. An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with the Administrator Jonna Lamb.the state’s words, verbatim · CDSS document, Mar 6, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.