Las Trampas - Sheila House

On 8/26/2025 at 10:30 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct 1-Year Annual Required inspection. LPA met Behavior Support Professionals (BSPs) Teresa Calderon and Susan Brinton, and explained the purpose of the visit. Susan phoned Administrator (AD) Kerri Nordstrom, who arrived around 11:00 AM. The facility’s fire clearance was approved for capacity of four (4) residents of which, two (2) may be non-ambulatory and two (2) ambulatory. Administrator Kerri Nordstrom, has an Administrator Certificate #6073133740 that expires on 12/3/2026. LPA toured facility with BSP Susan and AD including but not limited to bedrooms, bathrooms, kitchen, common area, backyard and garage. The facility consists of four (4) total bedrooms which 4 bedrooms are occupied by the residents and two (2) bathrooms. 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 residents’ shared bathroom was measured at 108.7 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 and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 12/12/2024. Emergency Disaster Plan was last reviewed on 8/1/2025. First aid kit was observed to be complete. Emergency disaster drill (fire and earthquake) was last conducted on 8/1/2025. LIC809-C Continued... 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 LPA reviewed four (4) residents records. LPA reviewed six (6) staff records and 6 of 6 have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications. LPA reviewed all four (4) clients P & I log. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/2/2025: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 309 Administrative Organization - Reviewed LIC 500 Personnel Report - Reviewed LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 08/14/2024 at 9:55 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met Direct Support Professional (DSP), Anthony Jones, and explained the purpose of the visit. Anthony phoned Director of Residential Services, Martha Rubio, who arrived around 10:10 AM. The facility’s fire clearance was approved for capacity of four (4) of which, two (2) may be non-ambulatory. DSP, Kerri Nordstrom, has an pending Administrator Certificate #6073133740. LPA toured facility with Martha including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms 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 residents’ shared bathroom was measured at 116.8 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 and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 01/08/2024. Emergency Disaster Plan was last posted on 08/01/2024. First aid kit was observed to be complete. Emergency disaster drill (fire and earthquake) was last conducted on 08/01/2024. LIC809-C Continued... 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 LPA reviewed 4 residents records. LPA reviewed 8 staff records and 8 of 8 have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 08/21/2024: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 309 Administrative Organization - Reviewed LIC 500 Personnel Report - Reviewed LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 07/26/2023 at 11:15 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Pre-Licensing inspection. LPA met with Assistant Director of Residential, Martha Rubio and explained the purpose of the visit. The facility currently has a fire clearance for 2 ambulatory and 2 non-ambulatory. LPA toured facility including but not limited to 4 bedrooms, 2 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a linen closet and cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 72 degrees Fahrenheit and hot water temperatures was measured 109.7 and 107.9 degrees Fahrenheit. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 01/13/2023. A sample of resident's medications was reviewed. No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.

On 07/26/2023 at 2:11 PM, Licensing Program Analyst (LPA) L. Alexander conducted a Component III Review, for the Pre-licensing Inspection which was conducted on this date with Martha Rubio, Assistant Director of Residential. LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participant gained knowledge about running and maintaining the facility in accordance with regulations. Exit interview conduct and a copy of this report provided.