Routine inspection·November 24, 2025

At approximately 1:15 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Administrator Henri Van Meines. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for six (6), with one (1) Hospice residents currently in care, and is approved for all non-ambulatory residents. At approximately 1:25 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 11/24. Smoke detectors are interconnected and carbon monoxide detector was tested and operational during inspection. Facility has recently installed a new water heater and is in the process of calibrating it, Licensee will keep a seven (7) water log and submit to LPA. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed one (1) locked shed unit and observed the contents to consist of resident care equipment and overflow storage. Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. Continued LIC809C... Continued from LIC809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 8/25. LPA observed facility's infection control plan and emergency disaster plan which was last updated 8/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. LPA observed a back up generator for emergency purposes. At approximately 1:55 PM LPA conducted a review of four (4) resident records. All required documentation present. At approximately 2:20 PM LPA conducted review of four (4) staff records. All required documentation present. At approximately 2:45 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Henri Van Meines Administrator Certificate 7020155740 expires 8/27. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : Liability Insurance LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.