Yannica Guest Home 2

Type of visit: Required - 1 Year

On 3/24/26, Licensing Program Analyst (LPA) Cynthia Tamayo arrived at this facility unannounced to conduct a required annual visit. Upon arrival, LPA met with the Administrator, Maxima Martin (S1), and informed them of LPA’s presence. An entrance interview was conducted. This is a Residential Care Facility for the elderly licensed to serve 6 non-ambulatory age range 60 and over , of which 1 may be bedridden in bedroom 1. Bedrooms 1,2,3,4 have approved egress. The census was 5 residents and 2 care staff. LPA Tamayo inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Tamayo observed the facility to be free of odor, clean and in good repair. There are no bodies of water present. LPA observed the the following when touring the physical plant: KITCHEN: Appliances and fixtures were clean and functional. LPA observed seven day non-perishable and two-day perishable food supplies. Meals are prepared by the Staff. Knives and other sharps are locked inaccessible in a drawer. Kitchen and house cleaning supplies are stored in a locked cabinet. LPA observed a weekly menu to be posted. COMMON AREAS: Common areas include the Living Room and Dining Room. All furniture was observed to be clean and in good condition, with enough seating for clients in care. There was space to accommodate both indoor and outdoor activities. LPA noted an Activity Calendar in the living room area and activities stored in the in the dining room. CONTINUED 809-C BEDROOMS: LPA inspected facility bedrooms. The facility has five (4) total client bedrooms and (1) staff bedroom. All bedrooms were observed to contain furniture, bedding and linens within regulation. Extra linens are stored in the hallway cabinet. Client bedrooms had no visible hazards or inconsistencies observed. BATHROOMS: There are three bathrooms. All bathrooms were observed to be clean and sanitary, and supplied with paper towels. Water temperature was tested and measured at 137.8 degrees F in the bathroom, which is not within the required regulation, the water temperature was adjusted during this visit to ensure water temperature is within 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. MEDICATION REVIEW: LPA reviewed medications which are centrally stored in a locked cabinet in the common area near the facility entrance. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. Fire drills are completed monthly. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. All emergency exits were clear from obstructions. area. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility's infection control plan as well as the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are within regulation. Both documents were observed to be complete and recently updated. Emergency disaster drill is conducted quarterly per regulation. EXTERIOR: Exterior passageways were clean and clear of any obstructions. There is a backyard patio area for client and visitor use with furniture observed to be in good condition. There are no exterior gates. There are two locked sheds for extra storage and furniture. RECORD REVIEW: LPA requested client and staff files for review. LPA reviewed 5 resident files and 3 staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprinted and associated to the facility. Administrator, S1, holds certification Administrator Certificate # 7032934740 expires on 8/15/2026. The following documents were requested to be sent to the Regional Office: (1) Insurance verification (2) Surety Bond (3)Resident Roster (LIC 9020) As a result of this annual visit, the facility is in compliance with Title 22 Regulation no deficiencies were cited. An exit interview was conducted with the Licensee, and a copy of these LIC 809 reports were left at the facility.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 04/02/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person, Rowena Dioso, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Maxima Martin, to inform her that CCL was present at this time for an annual visit. The facility designated Administrator returned back to this facility shortly thereafter while this LPA was conducting this visit. Current census was 6 residents. It was learned that there weren't any residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there was (1) resident receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 7032934740, for Maxima Martin was observed to have an expiration date of 08/15/2026 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility kitchen cabinet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication closet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers were located throughout this facility and observed to have been annually inspected by the local fire extinguisher company, Jorgensen Company, on 01/02/2025 and found to be in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted on the LIC 859. A review of (6) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Apr 2, 2025

Type of visit: Required - 1 Year

On 03/27/2024 Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Maxima Martin and explained the purpose of the visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate. The facility is licensed for six non-ambulatory residents, which one may be bedridden. The facility has an approve hospice wavier for 6. The LPA Martinez toured the facility with Maxima Martin on 03/27/2024 at 9:30 AM. The facility temperature measured at 72 degrees, and water temperature measured at 105 degrees. The facility was sanitary and furnished with no foul odors. The resident bedrooms and bathrooms were sanitary and furnished. The facility has an area for activities, and has a public telephone. The facility had an adequate food supply, and the kitchen was sanitary. The facility fire extinguisher, smoke detectors, and carbon detectors were in good repair. The fire emergency gate was in good repair. The exterior of the home was clear of debris. LPA Martinez conducted a facility file review, and files were maintained. Based on this annual inspection, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code. There were no deficiencies cited at this time, and exit interview was conducted. A copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 27, 2024