Golden Tiara Villa

Type of visit: Required - 1 Year

On 09/09/26, at 9:30am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annually required inspection visit to Golden Tiara Villa. LPA was met Arlene Feliciano, Administrator, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory residents, of which 1 may be bedridden and has a hospice waiver for four (4). Currently the facility has (5) residents. The facility’s annual fees were paid during the visit. The facility is a single-story structure in a residential neighborhood. It consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, office, storage room, front yard, back yard with a shaded patio, and detached garage. All bedrooms have exit doors and have access to a wheelchair ramp. There were no hazards or obstructions on the exterior of the facility. At 9:50am, LPA and staff toured the facility. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, and adequate storage for resident personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew, there was adequate lighting, and sufficient toiletries that were accessible to residents. The water temperature in the bathroom measured 123.2F degrees. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there is enough perishable and non-perishable food available for the residents. Report Continued On LIC809-C All food items were stored properly. The water temperature measured 144.3F degrees. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked with manual. The fire extinguishers were new and charged with current receipts. The smoke/ carbon monoxide detectors were operable. The last fire/emergency drill was conducted on 06/06/2026. The facility’s administrator’s certificate (7005359740) was valid from 04/04/2026 through 04/03/2028. The facility’s liability insurance was valid from 12/29/2025 through 12/29/2026. LPA conducted a review of (5) resident records, (3) staff records and reviewed the facility disaster plan. LPA observed that residents had the following documents in their file: Appraisal/Needs And Service Plan, Admission Agreement, Physician Report, Identification And Emergency Information, Personal Rights, and Consent Forms. Staff records were complete with required documents and training. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (4) resident medication administration records, and medication, and did not observe any discrepancies at the time of visit. LPA advised the facility to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues. The inspection tool was not available on the inspection; LPA used a manual RCFE paper inspection tool. Technical difficulties in FAS. DEFICIENCIES: LPA identified the following deficiencies during inspection visit: · Water temperature measured 123.2f degrees in the bathroom and 144.3f degrees in the kitchen. (Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105F degrees and not more than 120F degrees). Citation cleared on inspection visit. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D) for 87303(e)(2) Maintenance and Operation. An exit interview was held, appeal rights were given, and a copy of this Facility Evaluation Report was provided to Arlene Feliciano, Administrator.the state’s words, verbatim · CDSS document, Sep 9, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(2) · Plan of correction due date: Sep 9, 2026

87303(e)(2) Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105-degrees F and not more than 120-degrees F. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, LPA tested the water temperature in the bathroom, and it measured 123.2 and the kitchen measured 144.3degrees F, which poses a potential health, and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2026

Plan of correction: Licensee will adhere to Title 22 Reg 87303(e)(2) at all times. Licensee will ensure that water supply remain in compliance with hot water temperature of not less than 105 degrees F and not more than 120 degree F. Licensee agreed to immediately adjust the hot water temperature to ensure it remains within Title 22 regulations. Citation cleared on visit. LPA retested the temperature and it was within Title 22 regulations.

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Case Management - Other

On 06/11/26 at 9:30am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced case management visit to Golden Tiara Villa. LPA was met by Arlene Feliciano, Administrator. The purpose of the visit was to tour the facility, review resident files, and verify that the facility is operating within their fire clearance. The facility is licensed to serve residents aged 60 and over. The facility is approved for six (6) non-ambulatory residents, of which 1 may be bedridden and has a hospice waiver for four (4). On 06/09/26, the regional office received information that the facility has six (6) bedridden residents in care. The department toured the facility. The facility is a single-story home in a residential neighborhood. It consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, office, storage room, front yard, back yard with a shaded patio, and detached garage. All bedrooms have exit doors and have access to a wheelchair ramp. LPA reviewed five (5) resident physician’s reports and ID Emergency Information and observed that four (4) residents were non-ambulatory, and one (1) resident was ambulatory. LPA observed all residents in care and observed that the facility was incompliance with their fire clearance. No deficiencies were found and no citations were issued for this inspection visit. An exit interview was conducted with Arlene Feliciano, Administrator, and a hard copy of this Facility Evaluation Report was provided.the state’s words, verbatim · CDSS document, Jun 11, 2026

Type of visit: Required - 1 Year

On 09/18/25, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit using the CARE Inspection Tool. LPA met with Staff, Ricardo Huerbana, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) residents aged 60 and over. The facility is approved for six (6) non-ambulatory residents, of which 1 may be bedridden and a hospice waiver for four (4) residents. There are currently four (4) residents residing in the facility. Physical Plant/Structure The facility is a single-story structure in a residential neighborhood. It consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, sitting area, kitchen, storage room, front yard, back yard with a shaded patio, and detached garage. All walkways around the facility were observed clean, clear, and free of debris, obstructions, and hazards. LPA did not observe any bodies of water on the premises. Bedrooms LPA inspected the three (3) resident bedrooms and observed them to be clean and in good repair. All rooms were observed with the required furniture including beds, dressers, nightstands with lamps, and ample storage space for residents’ personal belongings. LPA observed the beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens, blankets, and comforters in good repair stored in a closet in the hallway. All bedrooms were observed with ample lighting. Bathrooms LPA inspected all bathrooms and observed them to be within Title 22 regulations and were clean and operational. All safety handrails were secured. LPA observed showers have non-skid mats and a shower chair. LPA observed an ample supply of hygiene products, incontinent products, and towels. The water temperature in the bathrooms measured 105.8- degrees and 105.5- degress Fahrenheit. Kitchen LPA inspected the facility kitchen and found it to be clean and sanitary. LPA observed all appliances to be operational and in good repair. LPA observed a 3- day supply of perishable foods and a 7-day supply of non-perishable foods, properly packaged, stored, and labeled. LPA observed all knives and sharps secured in a locked cabinet under the kitchen sink. LPA observed all cleaning and laundry supplies secured in a locked cabinet in the kitchen. LPA observed an ample supply of cookware, dishware, and cutlery in good repair. The water temperature in the kitchen measured 106.6- degree Fahrenheit. Common Rooms During the time of visit, LPA observed the facility to be appropriately furnished. The living room has recliners and a couch to accommodate all residents. The sitting area has a couch and lounger. LPA observed games, activities, puzzles, and reading material available for residents. The dining room has a large table with chairs to accommodate all residents. LPA observed a screened fireplace inaccessible to residents. The facility was maintained at a comfortable temperature. LPA observed all walkways and hallways in the home to be clean, clear, and free of obstructions and hazards. LPA observed all rooms and walkways have ample lighting. Files LPA reviewed the files for four (4) residents and found they contained the required documents. LPA reviewed the administrator and two (2) staff files and found they contain the required documents, certification, and training. The administrator’s Administrator Certificate, number 7005359740, is valid till 04/03/26. LPA observed all required posting posted throughout the facility. LPA received and reviewed a copy of the facility’s Liability insurance through Acord that is valid till 12/18/2025. LPA observed the facility’s Licensing Fees are current. Medications LPA observed all Centrally Stored Medication secured in a locked cabinet in the kitchen and are inaccessible to residents. Medications were observed in their original packaging. LPA reviewed the medications for four (4) residents and the Medication Administration Record (MAR) and found the medications to be consistent with properly documented records. Safety LPA observed the smoke and carbon monoxide detectors to be fully operational. LPA observed two fully charged fire extinguishers, one in the kitchen, and the other in the living room near the entrance, purchased on 04/21/25. The last emergency drill was conducted on 06/21/25. All exits are marked with an EXIT sign. LPA inspected the First Aid Kit and observed it has the required items and a current manual. The facility has a working landline telephone. LPA observed all emergency phone numbers and Emergency Disaster Plan posted in the kitchen. There are no firearms or ammunition stored on the premises. Infection Control LPA reviewed and observed the facility’s infection control plan posted on the wall. LPA observed sanitizing stations throughout the facility. LPA observed masks and gloves available. LPA observed staff wearing gloves while working with residents. LPA observed a 30-day supply of Personal Protective Equipment (PPE). LPA observed Infection Control signs posted throughout the facility. LPA did not observe or cite any deficiencies. An exit interview was conducted with Staff, Ricardo Huerbana, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 18, 2025

Type of visit: Required - 1 Year

On 09/27/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit using the CARE Inspection Tool. LPA met with Caregiver, Melita Jagmany, and the purpose of today’s visit was explained. We were later joined by Administrator, Arlene Feliciano. The facility is licensed to serve residents aged 60 and over. The facility is approved for six (6) non-ambulatory residents, of which 1 may be bedridden and a hospice waiver for four (4). There are currently five (5) residents living in the facility. Physical Plant/Structure The facility is a single-story home in a residential neighborhood. It consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, office, storage room, front yard, back yard with a shaded patio, and detached garage. All walkways around the home were observed clean, clear, and free of debris, obstructions, and hazards. LPA did not observe any bodies of water on the premises. Bedrooms LPA inspected the three (3) resident bedrooms and observed them to be clean and in good repair. All rooms were observed with the required furniture including beds, dressers, nightstands with lamps, and ample storage space for resident’s personal belongings. LPA observed the beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens, blanket, and comforters in good repair stored in a closet in the hallway. All bedrooms were observed with ample lighting. Bathrooms LPA inspected all bathrooms and observed them to be within Title 22 regulations and were clean and operational. All safety handrails were secured. LPA observed showers to have non-skid mats and a shower chair. LPA observed an ample supply of hygiene products, incontinent products, and towels. The water temperature in the bathrooms measured 107.8-degrees and 107.4-degress Fahrenheit. Kitchen LPA inspected the facility kitchen and found it to be clean and sanitary. LPA observed all appliances to be operational and in good repair. LPA observed a 3- day supply of perishable foods and a 7-day supply of non-perishable foods, properly packaged, stored, and labeled. LPA observed all knives and sharps to be secured in a locked cabinet under the kitchen sink. LPA observed all cleaning and laundry supplies secured in a locked cabinet in the kitchen. LPA observed an ample supply of cookware, dishware, and cutleries in good repair. The water temperature in the kitchen measured 107.6-degree Fahrenheit. Common Rooms During the time of visit, LPA observed the facility to be appropriately furnished. The living room has recliners to accommodate all residents. LPA observed games, activities and reading material available for residents. The dining room has a large rectangle table with chairs to accommodate all residents. The facility was maintained at a comfortable temperature. LPA observed all walkways and hallways in the home to be clean, clear, and free of obstructions and hazards. Files LPA reviewed the files for five (5) residents and found they contained the required documents. LPA reviewed the files for five (5) staff and found they contained the required documents, certification, and training. The Administrators Certificate is valid till 04/03/26. LPA observed all required posting posted throughout the facility. LPA received and reviewed a copy of the facility’s Liability insurance through Acord valid till 12/28/24. During facility file review LPA observed the facility’s Licensing Fees are current. Medications LPA observed all Centrally Stored Medication secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA reviewed the medications for five (5) residents and the Medication Administration Record (MAR) and the found the medications to be consistent with documentation. LPA observed all medication in their original packaging. Infection Control LPA reviewed and observed the facility’s infection control plan posted on the wall. LPA observed sanitizing stations throughout the facility. LPA observed masks and gloves available. LPA observed staff wearing gloves while working with residents. LPA observed a 30-day supply of Personal Protective Equipment (PPE). LPA observed Infection Control signs posted throughout the facility. Safety LPA observed the smoke and carbon monoxide detectors to be fully operational. LPA observed two fully charged fire extinguisher, one in the kitchen, and the other in the living room near the entrance, purchased on 02/20/24. The last emergency drill was conducted on 06/10/24. All exits are marked with an EXIT sign. LPA inspected the First Aid Kit and observed it to have the required items and a manual. The facility has a working telephone. LPA observed all emergency phone numbers and Emergency Disaster Plan posted in the kitchen. LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Arlene Feliciano, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 27, 2024

Type of visit: Required - 1 Year

On 12/5/23 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with caregiver Florencia Dupit, and the purpose of today’s visit was explained. LPA was granted access to the facility. Administrator Arlene Feliciano later joined LPA for this visit. The facility is licensed to operate for six (6) non-ambulatory age 60 and over, of which one (1) may be bedridden. Bedridden in any bedroom. Facility has a hospice waiver for four (4). Currently, there are five (5) residents in placement. The facility is a single-story structure located in a residential neighborhood. It consists of the following: two (2) client bedrooms, one (1) staff bedroom, two (2) bathrooms, living room, dining room, kitchen and an office. LPA and caregiver Florencia Dupit toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in adequate condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. The bathrooms were found to be within Title 22 regulation. Water temperature properly measured at 106.2 F in bathroom 1 and 106.7 F in bathroom 2. LPA observed a comfortable temperature was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene were stored and not accessible to clients. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Two fire extinguishers were fully charged, smoke detectors and carbon monoxide were operable. A review of Medication Administration Records was maintained in order and accurate. Continued on LIC 809-C The facility has a landline telephone on-site in working condition. Toxins and sharps were locked and inaccessible to clients. Medications were centrally stored and properly locked. First aid kit was checked an in order with manual. Outside grounds were toured and no bodies of water were observed. Patio furniture with umbrella was accessible. Exits and walkways around the home were free of debris and hazards. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved CCLD Mitigation Plan. No deficiencies were cited at the time of this visit. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Administrator Arlene Feliciano.the state’s words, verbatim · CDSS document, Dec 5, 2023