Routine inspection·March 27, 2026

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual inspection visit. LPA met with Cholly Sason and discussed the purpose of today’s visit. Tiffany Vander Poorten Administrator arrived shortly after. The facility is a single-story home located in Glendora, licensed to serve (6) non-ambulatory residents age range 60 and over. The facility has an approved Dementia Care Plan and a Hospice Waiver approved for (6) residents. LPA obtained a copy of a current liability insurance coverage. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. Smoke detectors were observed throughout the facility. Carbon monoxide detector is located in the hallway, was tested and operable. Two (2) fire extinguishers were observed, one located near the kitchen/dining area, and one located inside the laundry room. Last fire drill was conducted on 01/07/26. Bedrooms have the required furniture. Extra, clean linens were observed in a hall closet. Bathrooms have non-skid surfaces and grab bars. Hot water temperature measured at 109.4°F and 1009.5°F in the hallway bathrooms. Staffing : Facility is adhering to staffing requirements. continued on LIC809C Personnel Records-Training : LPA reviewed four (4)staff files. Staff have current First Aid/CPR certification, fingerprint/background clearance, and personnel record. 1 out of 4 files did not have a health screening for review. Deficiency cited. Resident Rights-Information: Resident rights are posted and are included in Resident files. Planned Activities: Activity provides planned activities. This facility also provides internet access to the clients. Food Service: There is sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed files for six (6) residents. Resident file has the required documents. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment and Preplacement Appraisal Information, Resident Pre-Appraisal. Resident Rights were observed. Disaster Preparedness: The facility has a Disaster Preparedness plan in place, last reviewed 2/26. LPA obtained a copy for facility file. Health Related Services/Incidental Medical Services: The medications centrally stored and locked. Medications are administered as prescribed. Physician's orders for bed rails were observed. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during today’s visit are documented on the LIC809D. Exit interview held and a copy of this report along with appeal rights were provided to Tiffany Vander Poorten.