Washington Family Manor

Type of visit: Required - 1 Year

On 3/4/2026 at 12:10 PM Licensing Program Analysts, LaVette Farlow and Paola Guerrero, (LPAs) arrived at Washington Family Manor unannounced to conduct the facility's Annual Inspection. LPAs Farlow and Guerrero were greeted and granted entry by Simone R. Harkless, House Manager. Simone R. notified the Administrator Simone Washington, of our arrival. LPAs was granted entry and provided space to work. LPAs later meet with and were greeted by Administrator Simone and stated purpose of the visit. LPAs were then accompanied by House Manager Simone R on a tour of the facility grounds. Facility: LPAs was informed that the current census is 4. The facility is licensed 6 non-ambulatory residents. Dementia Care Plan in place. Hospice Waiver approval of 2 residents, and diabetic and glucose monitoring approved. LPAs observed that the facility is operating at the capacity and in the conditions approved by Community Care Licensing (CCL). Physical Plant: LPAs observed the facility's temperatures to be comfortable. Sufficient lighting was provided by various lamps, fixtures and night-lights throughout the facility. LPAs observed carbon monoxide and fire alarms throughout facility. Administrator reports the facility conducts fire and disaster drills on a monthly basis. Fire extinguishers were observed to be fully charged January 22, 2026. The facility back yard contained a shaded space and adequate seating. The facility maintains its laundry room, extra hygiene and Personal Protective Equipment and extra supplies secure in the attached garage. The Living Room and Dining Room included activities, adequate seating and sufficient lighting. Please see LIC809-C LPAs tested the water temperature and the water measure at 118.8, which is within regulation. Resident Rooms included all required furnishings such as beds with appropriate linens, night stand, adequate lighting and seating. The facility does maintain a room for live in staff and staff files, resident files and medications secure. Food Service: LPAs observed the facility's food supply included a variety of items such as eggs, bread, milk, salad, fresh fruits and vegetables. Kitchen pantry with canned goods all in good standing. The amount of nonperishable and perishable food is sufficient for number of residents in care. LPAs observed that sharps, chemicals, cleaning supplies were kept in secure and inaccessible to residents in care. Care & Supervision: Facility has sufficient care staff; who assist residents 24 hours and 7 days a week. Administrator reported that 2 staff member lives on facility grounds and other staff assist daily as part time caregiver. A review of staff files revealed that all staff files contained verification of their annual training, criminal record clearance, health screenings, TB test results and First Aid/CPR. The Administrator's Administrator Certificate was observed in compliance. Resident Records: LPAs reviewed resident files for updated Physician's Report's, Needs and Services and Admissions Agreements. LPAs observed 3 out of 3 residents MARS and observed that the MARs were free of any discrepancy. Signs / Poster Emergency Disaster Plan, Long Term Care Ombudsman, Administrator Certificate, Personal Rights and Facility Sketch, Facility License, SEE/SAY are posted in a prominent place. Based on observations, staff interviews and record reviews, no deficiency cited per Title 22, California Code of Regulations. An exit interview was conducted and copy of this report reviewed and discussed, then provided to Administrator, Simone Washington.the state’s words, verbatim · CDSS document, Mar 4, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst, LaVette Farlow, (LPA) arrived at Washington Family Manor unannounced to conduct the facility's Annual Inspection. LPA rang the doorbell several times, made two calls, and stood outside for 5 minutes or more before being greeted and granted entry by Rachel Foster, Caregiver. Foster notified the Administrator Simone Washington, of my arrival. LPA introduced self and stated purpose of the visit. LPA was granted entry and provided space to work. LPA was then accompanied by Caregiver Foster on a tour of the facility grounds. Facility: LPA was informed that the current census is 3. The facility is licensed 6 non-ambulatory residents. Dementia Care Plan in place. Hospice Waiver approval of 2 residents, and diabetic and glucose monitoring approved. LPA observed that the facility is operating at the capacity and in the conditions approved by Community Care Licensing (CCL). Physical Plant: LPA Farlow observed the facility's temperatures to be comfortable. Sufficient lighting was provided by various lamps, fixtures and night-lights throughout the facility. LPA observed carbon monoxide and fire alarms throughout facility. Administrator reports the facility conducts fire and disaster drills on a monthly basis. Fire extinguishers were observed to be fully charged January 13, 2025. The facility back yard contained a shaded space and adequate seating. LPA observed the following tools out and unsecured on the patio a hammer, hand trowel, and tree trimmer. A deficiency was cited. Administrator agreed to remove during the visit. The facility maintains its laundry room, extra hygiene and Personal Protective Equipment and extra supplies secure in the attached garage. The Living Room and Dining Room included activities, adequate seating and sufficient lighting. Please see LIC809-C LPA tested the water temperature and the water measure at 127.7 and 125.7, which is very hot and out of regulation. Administrator did provide a log for the testing of the water temperature. A technical violation issued. Resident Rooms included all required furnishings such as beds with appropriate linens, night stand, adequate lighting and seating. The facility does maintain a room for staff where staff files, resident files and medications secure. Food Service: LPA observed the facility's food supply included a variety of items such as eggs, bread, milk, salad, fresh fruits and vegetables. Kitchen pantry with canned goods all in good standing. The amount of nonperishable and perishable food is sufficient for number of residents in care. LPA observed that sharps, chemicals, cleaning supplies were kept in secure and inaccessible to residents in care. Care & Supervision: Facility has sufficient care staff; who assist residents 24 hours and 7 days a week. Administrator reported that 1 staff member lives on facility grounds and herself or other staff assist daily as part time caregiver. A review of staff files revealed that all staff files contained verification of their annual training, criminal record clearance, health screenings, First Aid/CPR. The Administrator's Administrator Certificate was observed in compliance. Resident Records: LPA reviewed resident files for updated Physician's Report's, Needs and Services and Admissions Agreements. LPA observed 2 out of 2 residents MARS were inconsistent and had discrepancy. 2 out of 2 residents MARS did not have medication listed, a loose pills, discontinued medication still showing as being administered and not on the MARS. A deficiency cited. Signs / Poster Emergency Disaster Plan, Long Term Care Ombudsman, Administrator Certificate, Personal Rights and Facility Sketch, Facility License, SEE/SAY are posted in a prominent place. Based on observations, staff interviews and record reviews, 2 deficiency and 1 technical violation will be cited to address the concerns. Exit interview conducted and copy of this report was provided to Administrator/Licensee Simone Washington.the state’s words, verbatim · CDSS document, Mar 10, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst, Amber Coleman, (LPA) arrived at Washington Family Manor unannounced to conduct the facility's Annual Inspection. LPA rang the doorbell and was greeted by Simone Washington, Administrator. LPA introduced self and stated purpose of the visit. LPA was granted entry and provided space to work. LPA was then accompanied by Administrator on a tour of the facility grounds. Facility: LPA was informed that the current census is 2. The facility is licensed 6 non-ambulatory residents. Dementia Care Plan in place. Hospice Waiver approval of 2 residents. LPA observed that the facility is operating at the capacity and in the conditions approved by Community Care Licensing (CCL). Physical Plant: LPA Coleman observed the facility's temperatures to be comfortable. Sufficient lighting was provided by various lamps, fixtures and night-lights throughout the facility. LPA observed carbon monoxide and fire alarms throughout facility. Administrator reports the facility conducts fire and disaster drills on a monthly basis. Fire extinguishers were observed to be fully charged; last inspection date March 2023. The facility backyard contained a shaded space and adequate seating. Pathways contained some obstruction. Administrator agreed to remove during the visit. The facility maintains its laundry room, extra hygiene and Personal Protective Equipment and extra supplies secure in the attached garage. The Living Room and Dining Room included activities, adequate seating and sufficient lighting. Resident Rooms included all required furnishings such as beds with appropriate linens, night stand, adequate lighting and seating. The facility does maintain a room for staff where staff files, resident files and medications secure. Food Service: LPA observed the facility's food supply included a variety of items such as eggs, bread, milk, salad, fresh fruits and vegetables. Kitchen pantry with canned goods all in good standing. The amount of Nonperishable and perishable food is sufficient for number of residents in care. LPA observed that sharps, chemicals, cleaning supplies were kept in secure and inaccessible to residents in care. Please see LIC809-C Care & Supervision: Facility has sufficient care staff; who assist residents 24 hours and 7 days a week. Administrator reported that 1 staff member lives on facility grounds and there are 2 other staff who assist part time. A review of staff files revealed that all staff files contained verification of their annual training, criminal record clearance, health screenings, 1st Aid/CPR. The Administrator's Administrator Certificate was observed in compliance. Resident Records: LPA reviewed resident files for updated Physician's Report's, Needs and Services and Admissions Agreements. LPA observed 1 resident file without a current Physician's Report. Signs / Posters: Emergency Disaster Plan, Long Term Care Ombudsman, Administrator Certificate, Personal Rights and Facility Sketch, Facility License, SEE/SAY are posted in a prominent place. Based on observations, staff interviews and record reviews, 1 deficiency will be cited to address records. Exit interview conducted and copy of this report was provided to Administrator/Licensee Simone Washington.the state’s words, verbatim · CDSS document, Feb 15, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.