Routine inspection·September 4, 2025

At approximately 10:45am, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Charmaine Mendaros, Administrator was contacted via telephone and gave permission to begin inspection without them. Administrator arrived at facility at approximately 1:00pm. 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 four (4), is approved for five non-ambulatory residents and three (3) bedridden residents, and is vendored with the North Bay Regional Center (NBRC). At approximately 11:30am, LPA initiated a tour of the facility with staff and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices activated on all facility doors. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and 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 observed unlocked. Staff locked the cabinets and secured items immediately and agreed to maintain compliance moving forward. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. Continued on LIC809-C... Continued from LIC809C... LPA inspected a locked storage shed in the backyard which contained care equipment. LPA observed residents watching TV in their bedrooms and in the facility's common area. Facility has internet service and administrator agrees to purchase an internet access device which will be designated for resident use. The telephone was tested and was operational during inspection. Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 11/2024. Emergency Disaster Plan was reviewed and updated 10/2023. Facility conducts quarterly disaster drills with the most recent drill conducted 07/2025. At approximately 12:30pm, LPA conducted file review of three (3) staff and three (3) resident files. Three (3) of three (3) staff files reviewed contained all the required documents, proof of training and proof of current First Aid and CPR certifications. Three (3) of three (3) resident files reviewed contained all the required documentation. Administrator states that residents' families coordinate medical and dental appointments as well as transportation to a from these appointments, but facility assists with coordinating them as needed and has resources available for transportation if needed. Medications and medication records were inspected and the logs were observed maintained in compliance with regulation. Administrator understands that facility shall submit an affidavit and surety bond to the Department for any P&I resources the facility manages for residents. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC400 - Affidavit Regarding Client/Resident Cash Resources Surety Bond Emergency Disaster Plan (updated) Exit interview conducted with Administrator whose signature on form confirms receipt of documents.