Common Destiny

Type of visit: Required - 1 Year

On 1/6/2026 at 9:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this Required Annual Inspection. Upon entry, the LPA stated the purpose of the visit to Administrator Leonora Maquilan. At approximately 10:45 AM, Administrators Marvin Tom and Evelyn Hong Yuan arrived at the facility. The LPA toured the facility including but not limited to residents’ rooms, bathrooms, kitchen, common areas and the backyard. The LPA observed adequate lighting for the comfort and safety of residents in all rooms. Inside and outside areas are free of obstruction and no bodies of water. The temperature in the kitchen was measured at 68.7 degrees Fahrenheit at 10:15 AM. The maximum hot water temperature was measured at 115.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and slip-resistant mats. No smoking signs posted for residents on oxygen. There is more than the minimum of a one-week supply of nonperishable food and 2 days of perishable food. Centrally stored medications, sharps, and toxic cleaners are inaccessible to residents in care. The LPA observed the required postings in the facility, including the Residential Care Facility for the Elderly Complaint Poster, Ombudsman and Personal Rights posters, and the Theft and Loss Policy. Smoke detectors and carbon monoxide detectors were tested and found to be in operating condition. The fire extinguisher was fully charged and serviced within one year on 8/28/2025. The Emergency Disaster Plan was last reviewed on 5/1/2025. First aid kit was observed to be complete. Liability insurance expires on 12/7/2026. Facility cited because emergency, disaster, and fire drills were not conducted on a quarterly basis. The most recent drill was conducted on 5/1/2025. The LPA reviewed 5 resident records and 5 staff records. 1 B Type citation was issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Case Management - Other

On 01/30/2025 at 1:35 PM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct a Case Management visit. LPAs Care Staff, Leonora Maquilan, and explained the purpose of the visit. The Administrator/ Licensee was unable to come during the visit. On the annual inspection conducted on 01/07/2025, LPAs observed that R1 was on insulin on a sliding scale. Administrator requested an exception to retain R1 at the facility. During the visit, LPAs interviewed R1 to verify if resident is able to read and identify the amount of insulin the resident needs based on the reading. R1 stated that they are able to read the number on monitor, however, R1 is unable to determine the correct amount of insulin needed for the particular reading. R1 stated that they are unable to read the numbers on the insulin pen and stated that staff will help with dialing the number and poking the resident. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 30, 2025

Type of visit: Required - 1 Year

On 01/07/2025 at 09:00AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Care Staff, Leonora Maquilan, and explained the purpose of the visit. Care Staff stated that the Licensee/ Administrator has been out of the country since 12/19/2024 and not available. LPAs toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which all 5 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 68 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature was measured at 110.7 degrees Fahrenheit. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 09/12/2024. First aid kit was observed to be complete. Staff does not have access to the staff and resident files. Files were not available for review during the visit. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/21/2025 LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Infection Control Plan Continue to LIC809-C.. Continue from LIC 809.. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:10 AM, LPAs observed unlocked knives in the kitchen and unlocked insulin in the kitchen fridge accessible to residents. At 9:05 AM, LPAs observed that all staff and resident files were not available during the visit. At 9:15 AM, LPAs observed trash bags in the backyard and inside the garage that is not in the garbage bin due to an overflow. At 9:17 AM, LPAs observed the left side gate with a paddle lock. Staff admits that they lock the gate at night. Civil penalty of $500 is being assessed. At 9:20 AM, LPAs observed washing machine, stove, wheelchair, shower chair, RV, etc in the backyard. At 10:00 AM, LPAs observed R3 is on insulin sliding scale and unable to determine amount of insulin needed due to poor vision. At 10:15 AM, LPAs observed the Medication Administration Record not having an accurate record of dosages of medications The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with care staff. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 7, 2025

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA Luisa Fontanilla arrived unannounced to conduct an annual required inspection. LPA was met by staff Leonora Maquilan. LPA explained to staff the purpose of the visit. Administrator Marvin Tom was informed about the visit via telephone. Administrator arrived at approximately 12 noon. During the visit, LPA inspected the facility inside and out including but not limited to bedrooms, bathroom, kitchen, dining area, garage and backyard. Hot water in the kitchen measured at 109.7 Fahrenheit. A fire extinguisher that appeared full and last inspected on September 2023 was observed. Smoke detectors and carbon monoxide were tested and observed operational. First aid kit was reviewed and observed complete. At 11:15am, LPA reviewed 5 resident files and 4 staff files. At 3:10 pm, LPA interviewed 2 staff. The following deficiencies were observed: windows were observed with cobwebs/mold on window frame/certain screen windows with holes R5 is diabetic and on insulin but unable to manage own insulin and no approved exception S3 has Dementia; last Physician's Report date is 11/15/2021 No Resident Rights, Non discrimination and Resident Family Council posters The following records will need to be submitted to CCL by Monday, 1/29/24: Emergency Disaster Plan, Lic 500, Resident Roster and Disaster Drill. Deficiencies are cited per Title 22 California Code of Regulations (refer to Lic 809D). Exit interview was conducted and Appeal Rights was providedthe state’s words, verbatim · CDSS document, Jan 25, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.