Woodside Residential Care Facility for Elderly

On 9/15/2022, during the course of another visit, Licensing Program Analyst ( LPA ) K. Nguyen interviewed staff. Based on the interview, staff (S1) was present at the facility on 9/15/2022 and worked morning shift . Based on the interview with S1 has been working at the facility for about a 6months. LPA conducted records review using guardian system and S1 is not fingerprint cleared from DOJ & FBI. $500.00 Civil penalty was assessed. Civil penalty was assessed during today’s visit. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Deficiency, plan and proof of correction and civil penalty were discussed with Mirriam Paras. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided

On 08/14/2024 at 9:30 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. At 10:25 AM, LPA met with Administrator,Mariam Paras and explained the purpose of the visit. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 8/14/2024. Emergency Disaster Plan was last posted on 11/23/2022. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 04/08/2024. LPA reviewed 5 residents records and 5 staff records; all were complete. LPA also reviewed a sample of resident’s medications. The following documents were reviewed during the visit :LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, Liability Insurance and Current Administrator’s Certificate renewal documents. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 09/12/2023 at 9:30 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Mirriam Paras and explained the purpose of the visit. The facility’s fire clearance was approved for 9/06/2022. LPA toured facility with Mirriam including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 12 total bedrooms which 11 bedrooms are occupied by the residents and 3 bedroom is occupied by staff (up stair). All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 09/22/2025. Emergency Disaster Plan was last posted on 6/22/2023. First aid kit was observed to be complete. At 11:00am, LPA reviewed 6 residents records. At 12pm, LPA reviewed 5 staff records and 5 of 5 have current first aid training and associated to the facility. At 12:45pm, LPA reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 9/12/2023, during the course of another visit, Licensing Program Analyst ( LPA ) K. Nguyen interview Administrator upon observing S1 in the facility office. Based on the interview, staff (S1) was present at the facility on 9/12/2023 and worked morning shift. Based on the interview with S1 has been working at the facility for about a 1week. LPA conducted records review using guardian system and S1 is not fingerprint cleared from DOJ & FBI. $500.00 Civil penalty was assessed. Civil penalty was assessed during today’s visit. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties.

On this day at around 2:45 pm, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct a case management visit to follow up on the two residents that needed immediate placement from Montgomery Springs Manor. LPA spoke with Administrator Mirriam Paras on the phone and she authorized staff Lucille Cinco to sign the report. LPA observed there were 2 caregivers and one cook during the shift. LPA interviewed Resident 1 and Resident 2. They both said they are fine. Physician's Reports for both residents indicate they have Dementia. They both look clean and well-kempt. LPA did not observe any immediate health and safety issues during the visit. A copy of this report was provided to staff Cinco.