Genuine Love Care Home

Type of visit: Required - 1 Year

On this day, 8/14/26, at 11:15 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by staff, Amie Raymundo, and LPA informed the reason for visit. Administrator (ADM) Emelita Dimaguila arrived at 11:23 am. LPA started the inspection with Amie Raymundo and continued with ADM. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed sufficient for 2 days of perishables and 7 days of non-perishables. Central storage for medications and storage for cleaning supplies were observed locked. Kitchen drawer where sharps are kept was also observed locked. Fire extinguisher was observed fully charge and receipt shows purchased 7/13/26. Carbon monoxide and smoke detectors were tested and observed in operating condition on this day. Hot water temperature in the common bathroom was tested and measured at 119 degrees Fahrenheit. Facility conducts disaster drills at least every quarter and records showed last conducted 7/29/26. LPA reviewed 5 staff and 4 residents records. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Residents' P&I were checked and compared with last recorded balance. ......continued on 809C (page 2) Administrator to submit updated/current copies of the following documents by 8/28/26: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. Proof of Surety bond coverage LPA observed the following: at 2:10 pm, Resident R2's medical assessment (LIC602A) is over 2 years old and no longer consistent with R2's ambulatory status and no LIC625 Appraisal/Needs and Services Plan. from 2:10 pm to 2:45 pm, residents' (R3 and R4) medical assessments (LIC602As) are over a year old. from 2:20 pm to 2:45 pm, residents (R2 and R3) have no updated LIC625 Appraisal/Needs and Services Plan. at 3:10 pm, Resident R3' doctor's order for one of the medications is 325 mg 2 tablets every 4 hours PRN but label on this medication received by the facility showed 325 mg 1 tablet every 6 hours PRN. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $250.00 civil penalty each section #s' 87465(e) and 87463(a) are assessed for repeat violation within 12 month period. Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalty. Deficiencies and plan and proof of corrections were discussed with the administrator. Also discussed is the change in percent ownership of the corporation and Reporting Requirement Regulation. Administrator to update LPA when corporate officers made the final decision. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Aug 14, 2026

Type of visit: POC

While at the facility conducting the continuation of annual inspection, Licensing Program Analyst (LPA) Delmundo also conducted a POC visit. On 8/28/25, LPA issued a type A citation for deficiency section 87309(a) on with proof of correction to be submitted by 8/29/25. Emelita Dimaguila, administrator (ADM), submitted the POC on 8/29/25; however it was incomplete. LPA informed ADM of the above. ADM submitted the complete copy of POC on this same day, 9/03/25. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Sep 3, 2025

Type of visit: Case Management - Annual Continuation

On this day, September 3, 2025, at 12:45 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on August 28, 2925. LPA met with Emelita Dimaguila, administrator (ADM), and informed the reason for visit. LPA reviewed 5 staff and 5 residents' files. Medications checked, and compared with doctor's order and LIC622 Centrally Stored Medication and Destruction Records. Residents' P&I checked and compared with last recorded balance. LPA observed the following: -from 1:00 pm to 1:45 pm, staff (S3, S4 and S5) have not completed the required 40 hours training. -at 2:00 pm, resident (R1) does not have re-appraisal. -at 3:00 pm, R1 has 2 acetaminophen medications - 325 mg (filled 8/25/25) and 500 mg but latest order on file dated 7/10/25 is 500 mg. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Sep 3, 2025

Type of visit: Required - 1 Year

On this day, August 28, 2025, at 3:15 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by staff, Amie Raymundo. LPA met with Emelita Dimaguila, administrator (ADM), and informed the reason for visit. LPA also met with other staff, Ronaldo Dolente. LPA toured the facility inside out with ADM. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Fire extinguisher was observed fully charge and purchased on July 13, 2025. Carbon monoxide and smoke detectors were tested and observed in operating condition. Hot water temperature in the common bathroom was tested and measured at 108.1 degrees Fahrenheit. Facility conducts disaster drills at least quarterly and records showed last conducted July 25, 2025 LPA interviewed 4 residents. At 3:30 pm, LPA observed 2 lighters in the China cabinet without lock. ......continued on 809C (page 2) Administrator to submit updated/current copies of the following documents by September 11, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M liability insurance certificate 5. Proof of Surety bond coverage Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of correction by plan of correction due date may result in civil penalty. Deficiency and plan and proof of correction were discussed with the administrator. Due to time constraint, LPA to come back to continue inspection. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Case Management - Incident

On November 6, 2024, Emelita Dimaguila, administrator (ADM), sent a correspondence to Licensing Program Analyst (LPA) Delmundo. Correspondence indicated that resident (R1) who was admitted to the facility on October 25, 2024 and have prescribed medications of which 4 are available over the counter (OTC) were not received. The 4 medications were purchased on November 5, 2024. R1 missed the 4 medications from October 25, 2024 to November 5, 2024. On this day, November 15, 2024, LPA Delmundo arrived unannounced to conduct a case management in response to the above incident. LPA reviewed R1's file and documents LPA received. Written Special Incident Report (SIR) was submitted on November 8, 2024. Review of R1's records revealed the following: 1. LIC602A Physician's Report has no doctor's signature. 2. No LIC601 Identification and Emergency Contact Information 3. Facility received R1's P&I according to ADM and facility has not submitted an updated LIC400 Affidavit Regarding Client/Resident Cash Resources nor have obtained Surety Bond coverage. Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $250.00 civil penalty is assessed for repeat violation of deficiency section 87465(a). Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalties. Deficiencies, plan and proof of corrections, and civil penalty were discussed with the ADM. Exit interview conducted. Appeal Rights, LIC421FC, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Nov 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a) · Plan of correction due date: Nov 16, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. This requirement is not met as evidenced by: -Based on record review, the licensee did not comply with the section above in not obtaining R1's medications timely which posed an immediate health risk to person in care. This is a repeat violation within 12 month period. A citation was issued on 8/20/24.the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: Administrator to do the following and submit proof by 11/16/24: 1. Read the Regulations. 2. Come up with a plan of obtaining medications timely. A $250.00 is assessed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Nov 29, 2024

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. ....... This requirement is not evidenced by: -Based on interview and record review, the licensee did not comply with the section above in not obtaining medical assessment/LIC602A Physician's Report prior to admission which poses a potential health risk to person in care.the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: Administrator stated she'll bring R1 to the primary care physician on 11/19/24. Copy of LIC602A to be submitted by 11/29/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(a) · Plan of correction due date: Nov 29, 2024

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. -This requirement is not evidenced by: -Based on record review, the licensee did not comply withn the section above in not having LIC601 for R1 which poses a potential health and/or personal rights risks to person in care,the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: Administrator to complete the LIC601 and submit copy by 11/29/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87216(a)(1) · Plan of correction due date: Nov 29, 2024

87216 Bonding (a) Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. (1)The amount of the bond shall be in accordance with the following schedule...... -This requirement is not evidenced by: -Based on interview and observation, the licensee did not comply with the section above in not obtaining surety bond coverage which poses a potential personal rigths risk...the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: Administrator to obtain surety bond coverage and submit proof by 11/29/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87208(a)(9) · Plan of correction due date: Nov 29, 2024

87208 Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation... Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval.. (9) A statement whether or not the applicant will handle residents' money..... This requirement is not met as evidenced by: -Based on observation, interview and record review, the licensee did not comply with the section above in not submitting an updated LIC400.the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: Administrator to submit an updated LIC400 by 11/29/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Nov 29, 2024

87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted.... within seven days of the occurrence of any of the events...(D) Any incident which threatens the welfare, safety or health of any resident... -This requirement is not met as evidenced by: -Based on document review, the licensee did not comply with the section in not submitting an incident report in timely manner which posed a potential health and/or personal rights risks to person in care.the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: Corrected. Report submitted on 11/08/24.

Type of visit: POC

On this day, August 28, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct proof of correction (POC) visit. LPA met with Emelita Dimaguila, administrator, and informed the reason for LPA's presence. On August 20, 2024, LPA issued citation for deficiency section # 87465(a) for R1's 3 medications with POC to be submitted by August 21, 2024. The administrator submitted proof for 2 medications only. The POC for 40 mg of Pantropazole is still not submitted until this date. A civil penalty is assessed for $100.00 per day and will continue until corrected, Civil penalty = $100.00/day x 7 days (August 22, 2024 to August 28, 2024) = $700.00 Civil penalty was discussed with the administrator. Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty Assessment, and copy of this report provided.the state’s words, verbatim · CDSS document, Aug 28, 2024

Type of visit: Required - 1 Year

On this day, August 20, 2023, at 2:00 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by Harold Dimaguila, staff. LPA met with Emelita Dimaguila, administrator, and informed the reason for visit. Facility has Infection Control Plan that was submitted on August 2, 2022. LPA toured the facility inside out with the administrator. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Fire extinguisher purchased on was observed fully charge and purchased on Carbon monoxide and smoke detectors were tested and observed in operating condition. Hot water temperature in the common bathroom was tested and measured at 118.5 degrees Fahrenheit. LPA reviewed 5 staff and 1 residents files, and interviewed 1 resident. Facility does not handle residents' cash resources. Medications checked, and compared with doctor's order and LIC622 Centrally Stored Medication and Destruction Records. LPA observed the following: -at 2:05 pm, staff who stated she's been at the facility since Sunday, 8/18/24, is not fingerprinted. -at 2:12 pm, scissors and Vicks vaporub in the table in the living room. -at 2:14 pm, peeler, grater in kitchen drawer without lock. -at 2:15 pm, staff's medications in another kitchen drawer without lock. ......continued on 809C (page 2) Page 2 -at 2:19 pm, resident's medications in the refrigerator in the kitchen. -ar 2:25 pm, disinfectant spray and Polident denture cleaner in bathroom cabinet without lock. -from 2:32 to 2:34 pm, missing baseboard and water stained baseboards and siding in one of the residents' room. Mildew in the common bathroom. -at 2:40 pm, resident R1's bed has half bed rails but no doctor's order on file -at 3:00 pm, facility does not have telephone service and does not conduct disaster drill. -at 4:00 to 4:30 pm staff (S3, S4 and S5) do not have First Aid certificate and no 40 hours required training, 10 hours on the job training and medication training on file. S5 does not have LIC501 Personnel record. S4 and S5 do not have LIC503 Health Screening record on file. -at 6:30 pm, resident (R1) has doctor's order for 3 medications but the facility does have them. Administrator to submitted the following updated/current documents on this day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $300.00 civil penalty is assessed for deficiency section 87355(e)(1) for staff who is not fingerprinted, and will continue for $100.00/day until corrected. Failure to submit proof of corrections by plan of correction due dates for other deficiencies may result in additional civil penalties. Deficiencies, plan and proof of corrections, and civil penalty were discussed with the administrator, Exit interview conducted. Appeal Rights, LIC421IM, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Aug 20, 2024