Am Residential Care Home

On January 6, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced plan of correction visit. Upon entry, LPA met with caregiver, Delilah Nicodemus and house manager, Rosita Padolina. The administrator, Katie Eiseman arrived shortly thereafter and assisted with the visit. During today's visit, LPA observed sharps are locked and inaccessible to residents in care and there were no medications that were transferred from its original container to a weekly organizer. However, LPA observed one of resident #1 (R1)'s medication did not have a physician order and this observation was made during the case management visit on 12/17/2025. A civil penalty of $250 is being assessed today for repeat violation. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. This report is reviewed and discussed with the administrator. A copy of this report and the appeal rights were provided.

On December 17, 2025, Licensing Program Analyst (LPA) Murial Han conducted a case management visit to follow-up on the pre-licensing inspection findings that were observed for Heritage Manor. LPA met with administrator, Katie Eiseman explained the purpose of today's visit. During the pre-licensing inspection, LPA observed sharps were not locked and accessible to residents in care. During medication review, LPA observed some of resident #1 (R1), resident #3 (R3), and resident #6 (R6)'s medications did not have a written order from the physician. During the medication review, LPA also observed resident #2 (R2), resident #4 (R4), resident #5 (R5), and R6's medications were removed from its original contains and pre- poured into a weekly medication organizer. According to Staff #1 (S1), the medications were prepared for a later shift. LPA requested for a copy of the current medication list/prescription for R1, R3 and R6 to be submitted by 12/18/2025. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with the administrator. A copy of this report and the appeal rights were provided.

On October 2, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. Upon entrance, LPA was greeted by caregiver Delilah Nicodermus and LPA explained the purpose of the visit. House Manager Rosita Padolina and Administrator, Katie Eiseman arrived shortly thereafter and assisted with the annual inspection. The facility is licensed for a capacity of 6 non-ambulatory residents of which 3 may receive hospice care services. There are 2 residents receiving hospice services at this time. LPA toured the facility inside and outside including the bedrooms (4 private and 1 shared rooms), 1 full- bathroom, kitchen, living room and common areas. Staff rooms are located on the 2nd floor. The facility observed to clean, tidy and in good repair. Bedrooms were equipped with the required furniture for residents to use. Bathroom is equipped with grab bars, and in good condition. Facility temperature is comfortable. Hot water temperatures in the kitchen and bathroom was measured at 105- 110 degrees F. LPA observed 2-day perishables and 7-day non-perishables. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors in the facility. Fire extinguishers were last inspected on 8/8/2025. Medication, and disinfectants were observed to be locked and inaccessible to residents. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 At 10:20AM, during the facility tour with the house manager, LPA observed the sharps that were stored in the kitchen drawer was unlocked. A review of (6) resident files was conducted and noted on the LIC 858. A review of (4) staff files was conducted and noted on the LIC 859 and LPA observed Staff #1 (S1)'s Criminal Record Clearance transfer was incomplete. The administrator will provide a copy of the Liability Insurance to CCL by 10/3/2025. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with the administrator and the house manager. A copy is provided and the appeal rights.

On 10/22/2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. Upon entrance, LPA met with caregivers Imelda Silo and Zenaida Tarrazona and LPA explained the purpose of the visit. Caregivers contacted the lead caregiver, Rosita Padolina of LPA's inspection who arrived shortly thereafter as well as the administrator, Katie Eiseman. The facility is licensed for a capacity of 6 non-ambulatory residents of which 3 may receive hospice care services. There are 3 residents receiving hospice services at this time. LPA toured the facility inside and outside including the bedrooms (4 private and 1 shared rooms), 2 full- bathrooms, kitchen, living room and common areas. The facility observed to clean, tidy and in good repair. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and in good condition. Facility temperature is comfortable. Hot water temperatures in the kitchen and bathroom was measured at 105- 110 degrees F. LPA observed 2-day perishables and 7-day non-perishables. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors in the facility. Fire extinguishers were last inspected on 8/8/2024. Central stored medication, toxins and sharps objects were observed to be locked and inaccessible to residents. A review of (6) resident files was conducted and noted on the LIC 858. A review of (3) staff files was conducted and noted on the LIC 859 During the tour of the facility, LPA observed a table, folding chairs and personal belongings in the garage and according to staff, the garage is being used as staff breakroom. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with the administrator. A copy is provided and the appeal rights.