Spyglass Senior Villa Ii

On 05/22/2025 at 1:35PM, Licensing Program Analysts (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Gloria Rueda, Caregiver who spoke with Administrator Rakhee Sharma via telephone, and explained the purpose of the visit. LPA reviewed CCLD portal which shows, Administrator currently holds a certificate (#7017005740) that expires on 08/21/2026. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPA did not observe any bodies of water. A comfortable temperature is maintained at 70 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 109.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and no skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/08/2024. Emergency Disaster Plan was last posted on 05/22/2025. First aid kit was observed to be complete. Fire drill was last conducted on 03/25/2024. Continued on LIC809C. 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 Continued from LIC809 LPA reviewed five (5) resident records and three four (4) staff records, and they were current and complete. LPA also reviewed a sample of medications. LPA requested the following documents to be submitted to CCLD by 05/29/2024 : · LIC 200 and Updated Facility Sketch · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report (Updated) · LIC 610E Emergency Disaster Plan · Liability Insurance LPA observed no deficiencies during visit Exit interview conducted. A copy of this report provided .

On 05/16/2024 at 10:50AM, Licensing Program Analysts (LPA) T.Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Caregiver Gloria Rueda, spoke with Administrator Rakhee Sharma via telephone, and explained the purpose of the visit. The Administrator arrived at 11:08AM and currently holds a certificate (#6049443740) that expires on 08/21/2024. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPA did not observe any bodies of water. 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 110.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and no skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/10/2023. Emergency Disaster Plan was last posted on 05/08/2024. First aid kit was observed to be complete. Fire drill was last conducted on 03/25/2024. Continued on LIC809C. 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 Continued from LIC809 LPA reviewed five (5) resident records and three four (4) staff records, and they were current and complete. LPA also reviewed a sample of medications. LPA requested the following documents to be submitted to CCLD by 05/23/2024 : · LIC 200 and Updated Facility Sketch · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report (Updated) · LIC 610E Emergency Disaster Plan · Liability Insurance · Current Administrator's Certificate LPA observed no deficiencies during visit Exit interview conducted. A copy of this report provided

On 9/15/21 at 10:30 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Gloria Rueda, Care Staff and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory clients LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms of which 4 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the kitchen sink was measured at 113.5 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 detector were in operating condition during visit. Fire extinguisher was last serviced on 10/13/22. First aid kit was observed to be complete. Fire drill was last conducted on 9/7/23. At 11:00 a.m., LPA reviewed 4 residents records. At 12:00 p.m., LPA reviewed 5 staff records and 5 of 5 have current first aid training and associated to the facility. At 11:45 a.m., LPA reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 02/02/2023 at 2:40PM, Licensing Program Analyst (LPA) L. Ibo conducted an unannounced case management about Death report received on 01/30/2023, R1 passed away with unknown cause of death. LPA met with Administrator, Rakhee Sharma. During the course of investigation, based on the interview with staff, R1 did not show any signs of medical emergency throughout the day. At around 2:00PM-4:00PM R1 took a nap. At around 3:30PM, S2 checked R1, it was observed that there was no sign of any medical emergency. R1’s family member visited her. Family member of R1 found her unresponsive at around 04:30PM. Staff called 9-1-1, paramedics arrived and pronounced R1 death at 4:43PM. R1 passed away on 01/29/2023. Based on Police report it revealed that there was no foul play or any sign of abuse. Based on interview with Administrator, R1 was under the care of hospice from 01/24/2022 and was discharged on 04/23/2022 with admission diagnosis of Cerebrovascular disease. No deficiency cited during this visit. Exit interview conducted. A copy of this report and was provided.

On June 22, 2022 at 9:55 AM, Licensing Program Analyst (LPA) Leslie Ibo arrived unannounced to conduct an infection control annual inspection. LPA met with Eufrecina Metra staff and Rhonette Santos house manager informed the purpose of visit. LPA called Administrator and informed her the purpose of the visit. Administrator arrived at the facility around 11:10AM. Facility has census of 5. Hospice waiver approved for 4 residents. Currently facility has 1 hospice resident in care. LPA started the inspection with Eufrecina Santos. LPA toured the facility inside and out including but not limited to common areas, resident rooms, bathrooms, kitchen, garage and backyard and side yard. Facility has enough supplies of PPEs, paper supplies and hygiene supplies. Medications are centrally stored in a locked area that is inaccessible to clients and refilled every 30 days. Water temperature was tested in the common bathroom and measured at 109.7 degrees Fahrenheit. Fire extinguisher checked; tag showed inspected on October 2021. No deficiency cited during the visit. Exit interview conducted with Rakhee Sharma. Appeal Rights and copy of this report provided.