Bay Leaf Elderly Care Home Llc

On 9/4/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility for the purpose of conducting a closure visit initiated by the Licensee. LPA Calandra was greeted by Cassandra Rose, Administrator and explained the purpose of the visit. LPA conducted a walk-through of the facility, inspected all rooms and common spaces. There are currently no residents living in the facility and the last resident moved out on 8/29/2025. LPA was provided with a list of all residents and relocation sites and given updates throughout the months leading up to the final closure. During today's inspection, LPA Calandra found no evidence to suggest that there are any residents in care. Administrator stated that residents have taken selected personal belongings and furnishings for transfer to their new facilities. The facility files for both residents and staff will be kept in storage for 3 years. The Licensee initiated this facility closure and submitted a written statement to Community Care Licensing (CCL) on 6/1/2025, requesting to close this facility. All residents were found to be safely relocated. Closure inspection of this facility has been completed. Facility has surrendered the license to LPA Calandra. The Department will be moving forward with the closure process. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Cassandra Rose, Administrator and a copy of the report left at the facility.

On 8/22/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Plan of Correction(POC) visit to clear the citation delivered on 8/13/2025. LPA Calandra was greeted by Cassandra Rose, Administrator and explained the purpose of the visit. On 8/13/2025, the facility was cited for a violation of California Code of Regulations(CCR) 87407(a) : Administrator Certification Requirements as the Administrator on record at the time of the visit, Mayeanne Guinona did not have an active Administrator's Certificate. During the visit on 8/22/2025, LPA Calandra was able to verify that Cassandra Rose, has an active Administrator Certificate. On 8/13/2025, the facility was cited for a violation of CCR 87303(a)(1) Maintenance and Operations as the Licensee had not maintained the facility in a clean and sanitary condition. During the visit on 8/22/2025, LPA was able to verify that the facility had been cleaned. An exit interview was conducted. A copy of the report and the POC clearance letter were left at the facility with the facility representative.

On 8/13/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management in regards to notification that the facility was planning to cease operations as of October 2025. LPA Calandra was greeted by Cassandra Rose, Administrator and explained the purpose of the visit. LPA received copies of the eviction notices via email while at the facility. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of the report left at the facility with facility representative.

On October 14, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 8:40 AM to conduct the unannounced Annual 1-year required inspection. LPA Calandra was greeted by Mayeanne Guinomma, Licensee/Administrator and Cassandra Rose, Caregiver and explained the purpose of the visit. LPA Calandra toured the physical plant. This is a 1-story building with 5 bedrooms, 3 bathrooms, backyard, kitchen, living room, dining room, and office. All bedrooms had the required furniture and sufficient lighting. Hot water temperature was measured within the required 105-120 degrees Fahrenheit. No accessible bodies of water or hazards were observed in the front or back yards. Night lights were observed in the hallways. The facility's Smoke Alarms and Carbon Monoxide detector were observed to be in working order. The facility's first aid kit was observed to have all required items. The facility had the required 7 days of non-perishables and 2 days of perishables; No food was expired. All sharp objects, medications, poisons, and cleaning supplies were locked up and in-accessible to persons in care. LPA reviewed 4 resident records and 3 staff records. All were observed to be complete. LPA interviewed 3 residents. LPA requested the following documents be sent to the Regional Office/Licensing by 10/21/2024: -Current lease agreement -Current LIC 500 -Current Liability Insurance A review of resident medications showed that all medications matched the Centrally Stored Medication Records kept at the facility. No deficiencies were cited during today's visit. This report was reviewed with Mayeanne Guinomma, Licensee/Administrator and Cassandra Rose, Caregiver and a copy of the report was left at the facility.

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with licensee Mayanne Avena and explained purpose of today's visit. LPA conducted a tour of the facility's physical plant and grounds. There are no accessible bodies of water or fire safety hazards are observed. Infection control practices are reviewed: Entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. PPE supply is adequate and infection control signs are posted prominently. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is being maintained, and lighting is sufficient for comfort and safety. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is present. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed; first-aid training for staff is current. Staff training is current according to administrator. Anna is a certified RCFE administrator (x 08/2022) that oversees facility operations. There is an additional administrator on record who is present today as well, Gabriel Schoof, whose administrator certificate is current (x07/2023). According to licensee she is awaiting to receive administrator course training hours that is scheduled for December 2022. Water temperature is tested at 105F in private resident full bathroom and tested at 115F in common bathroom in main hallway. Bathrooms and shower rooms have grab bars and non-skid mats in showers. PPE is observed as in place in exterior storage building. Fire extinguishers are charged and ready for use last being inspected on 11/29/2021. LPA did observe one fire extinguisher that needs charging but the other fire extinguishers are charged and ready for use. Smoke alarms and carbon monoxide detectors are in place through out. Food supplies are in place. Facility does not handle resident cash resources. The following updated forms are being requested to be received by 10/27/2022: • LIC610E Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report There are no citations issued during today's inspection. Report is reviewed with licensee Mayanne Avena.

On 09/16/2021 at 0900hrs Licensing Program Analyst (LPA) Jaime Vado and Komal Charitra conducted an unannounced prelicensing inspection visit. LPA met with licensee/administrator Mayanne and explained purpose of today's inspection. LPAs made observations within the facility. LPAs inspected three facility bathrooms and all are in good condition. Faucets operate appropriately. Water temperatures are taken at all three faucets. Main bathroom located adjacent to living room water temp is 112F. Bathroom in hallway faucet temperature is measured at 107F. Bathroom water temp in resident room is measured at 107F. Facility floors are observed as clean and with no debris. Facility fire drill log is observed as current. Last fire drill was conducted on 08/14/21. Backyard is observed as clear of boxes that were previously there on prior visit. Cleaning solutions are observed in locked hallway closet. Facility PPE is present. Facility food supplies are in place. Kitchen is observed as clean. As a result of inspection today, the physical plan of this home is in substantial compliance with the Regulation requirements for a Residential Care Home for the Elderly today, and is pending the completion of all documentation and the final approval of the Centralized Application Unit (CAU). Component three is conducted today with licensee.

On 08/04/2021 at 1100hrs Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced prelicensing inspection visit. LPA met with licensee/administrator Mayanne and explained purpose of today's inspection. During today's inspection LPA toured the facility inside and out. This is a single story facility. Ambient temperature is observed as 72F. Fire lanes are clear on the outside of the facility. All resident bathrooms are inspected. Of the three, two do not have fully functioning faucets. Bathroom in main hallway does not produce hot water and knobs do not allow free flowing water. Bathroom in resident room faucet does not function at all but toilet and shower are operable. Main bathroom adjacent to living room is considered the main shower and bathroom. Faucet and shower functions appropriately. Water is tested at 125F at this time. 48hr fresh food supply is present. There are two freezers present as well and supplies are in place. Two week canned and dried goods are observed as in place. Resident bedrooms have all required furniture in place. Linens are observed as in place. Medications are locked and secured in office area. First aid kit is complete. Fire extinguishers are in place and fully charged. Fire alarms are hardwired in place and carbon monoxide detector is observed as plugged in adjacent to the kitchen. Cleaning solutions are observed as stored in hallway closet but is not locked. LPA did observe that the kitchen sink is full of dishes that require washing but this was corrected during today's inspection. Backyard had boxes of items that are in the process of being moved. Main dining table has paperwork and files that need organizing. Resident and staff files require organization. Facility floors do have areas with debris and foot prints from water near bathroom adjacent to living room. Areas in facility observed as well with dusty and spider webs. Resident files are reviewed as current but require updated admission agreements reflecting new facility. Fire drill log was not able to be reviewed. Facility does not handle cash resources of residents. Administrator certificate is current expiring on 8/5/2022. The following updated forms are to be received by 08/20/2021: LIC500 LIC308 LIC610E Copy of current administrator certificate Report is reviewed with administrator/licensee.

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 2 COMP II Participants: Mayanne Avena Interview Method: Telephone interview On 6/4/21, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readiness