Villa Marcosa

Type of visit: Required - 1 Year

On 09/11/26, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced 1-Year Required Annual Visit using the CARE Inspection Tool. Due to technical difficulties, LPA unable to generate an electronic CARE inspection tool and instead used a printable/PDF version. California Department of Social Services (CDSS) was met by Rosita Matute, Administrator, and the purpose of today’s visit was explained. This facility is licensed to serve 6 non-ambulatory residence over 60 years old. A total of five (5) residents are currently residing in this facility. Facility has a hospice waiver for 6. The facility is a single-story home located in a residential neighborhood. The home has dual entry doors that open into a foyer. There are five (5) resident bedrooms, three and a half (3 1/2) bathrooms, dining room, living room, laundry room off of kitchen area. There is an attached garage, with a deep-freeze unit. The facility has a pool that is gated with required locking on the gate, inaccessible to residents in care. CDSS inspected all 5 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Toilets and water faucets worked properly, grab bars were secure, with non-skid mats in place. Adequate lighting and toiletries are accessible to residents. CDSS tested hot water temperature and it measured within title 22 regulation, at 108.6°F (degrees Fahrenheit). This facility provides residents with hygiene products such as non-medicated soap, toilet paper, toothbrush, toothpaste shampoos, lotions. The living room is fully furnished with sofa, 2 chairs, coffee table, 3 recliners and mounted TV. There is adequate space for activities and there are adequate activity supplies in place. CDSS observed all required documents posted throughout the facility. The facility has a working land line telephone. Report continues, please see LIC809-C. CDSS inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls, all in good repair. CDSS observed knives and additional sharps secured in garage area, inaccessible to residents in care. CDSS observed 2-day supply of perishable foods and 7-day supply of non-perishable foods properly stored, packaged, and labeled. First aid kit is fully stocked with all required items. CDSS observed two (2) fully charged fire extinguishers, last serviced on 7/3/24. According to Title 22 regulation 87203, "All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.", which states that an extinguisher "must be serviced and tagged annually by a licensed professional". One deficiency has been cited, please see LIC809-D. The last emergency drill was conducted on 7/11/26. Smoke/Carbon Monoxide detectors were tested and operable, all interconnected. LPA reviewed five (5) resident files and found that 5 out of 5 resident folders have the required documents. LPA reviewed three (3) staff files and found that 3 out 3 had all required documents, training, and certifications. LPA reviewed a copy of the facility’s Liability Insurance with expiration date of 9/25/26. LPA observed all centrally stored medications secured All medications were observed in their original packaging. The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites, last updated on 04/26 (dated April 2026). Facilities' Administrator, certificate number 7006130740, is valid through 10/15/2026. During today’s visit there has been one (1) deficiency cited. An exit interview was conducted with Rosita Matute - Licensee/Administrator and a copy of one (1) deficiency, this report, and facilities' appeal rights have been provided.the state’s words, verbatim · CDSS document, Sep 11, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87203 · Plan of correction due date: Oct 1, 2026

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This has not been met as evidenced by LPA observation, which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: LPA and Licensee have agreed that the facility will have their fire inspector come to perform the annual maintenance inspection of two (2) fire extinguishers on, or prior to, the POC due date. Licensee will forward photographs of the annual maintenance having been performed, via email, at MARIO.LEON@DSS.CA.GOV

Type of visit: Required - 1 Year

On September 15, Licensing Program Analyst (LPA), Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA Lee met with Jun Fausto Figueroa and the purpose of today’s visit was explained. This facility is licensed to serve 6 non-ambulatory residence over 60 years old. A total of 6 residents are currently residing in this facility. There is a hospice waiver for 6. Physical Plant/Structure : The facility is a single-story home located in a residential neighborhood. The entry way of the home is clear and free of debris and obstruction. The home has dual entry doors that open into a foyer. There are 5 resident bedrooms, 3 1/2 bathrooms, dining room, living room, laundry room off of kitchen area. There is an attached garage. The facility has a pool that is gated with required locking on the gate. According to licensee, the pool will not be accessible to residents, as it is a "show piece" feature of the house. Bedrooms: LPA inspected all 5 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Page 1 of 3 Bathrooms: Toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries are accessible to residents. LPA tested hot water temperature, and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products such as non-medicated soap, toilet paper, toothbrush, toothpaste shampoos, lotions. Common Rooms: The living room is fully furnished with sofa, 2 chairs, coffee table, 3 recliners and mounted TV. There is adequate space for activities. Required Postings: LPA observed all required documents posted throughout the facility. The facility has a working landline telephone. Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in garage area and are inaccessible to residents. LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. First aid kit is fully stocked with the required items and a manual. Page 2 of 3 Safety LPA observed 2 charged fire extinguishers last serviced on 7/3/24 The last emergency drill was conducted on 5/14/2025. Smoke detectors were tested and operable. File Review: LPA reviewed 6 resident files and found that 6 out of 6 had the required documents. LPA reviewed 3 staff files and found that 3 out 3 had the required documents, training, and certifications. LPA reviewed a copy of the facility’s Liability Insurance with expiration date of 9/25/26 Medications LPA observed all centrally stored medications secured All medications were observed in their original packaging. Infection Control LPA observed required infection control signs posted throughout the facility. LPA observed sanitizing station in the entry way of facility. LPA observed an ample supply of PPE on hand for use when needed. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Facility maintains documentation of the required emergency drills. Emergency Intervention: Clients at this facility do not need the use of restraints or de-escalation techniques. During today’s visit there were no deficiencies. An exit interview was conducted with Jun Faust Figueroa and a copy of this report was provided. Page 3 of 3the state’s words, verbatim · CDSS document, Sep 14, 2025

Type of visit: Prelicensing

On August 23, 2024 at 9:00am, Licensing Program Analyst (LPA), Deborah Lee conducted an announced visit to the facility for the purpose of conducting a pre-licensing evaluation. An application was submitted to CCLD on August 15, 2024 for opening a new facility for an Adult Residential Care Facility for the Elderly (RCFE) to serve 6 clients 60 years and over. Hospice waiver granted for 6. LPAs met with Rosita Matute Licensee and Novela Punzalan, Assistant Admintrator, and explained that the purpose of today’s visit together toured the physical plant(inside and outside). Overview of Facility: Facility is a mid-century single story home located in a residential neighborhood. The entry way of the home is clear and free of debris and obstruction. The home have dual entry doors that opens into a foyer. There is a sanitation station as you enter the facility. There are 5 resident bedrooms, 3 1/2 bathrooms, dining room, living room, laundry room off of kitchen area. There is an attached garage. The client bedrooms are spacious and easily accommodate the client's furnishings. The facility has a pool that is gated with required locking on the gate. According to licensee, the pool will not be accessible to residents, as it is a "show piece" feature of the house. The shaded area and outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPAs did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Bedrooms Residents: Bedrooms 1-5 have working lights, new blinds and working windows with no bars. Only 1 of the 5 bedrooms will be shared, the rest are will be private rooms. Bathrooms: All Bathrooms have a working toilet, wash basins and shower, and observed to be clean, safe, and sanitary. LPAs observed adequate lighting in throughout the entire facilty Linens & Hygiene Supplies: Extra linens are in hallway closet. Living room is fully furnished with sofa, 2 chairs, coffee table, and mounted TV. There is adequate space for activities. . The dinning area is equipped with a large square dinning set that seats 6-8 comfortably. Facility has a lanline phone for emergencies. There are two fully charged fire Extinguishers located in the kitchen and living room areas. LPA observed all required postings. Smoke Detectors: Facility has 7 smoke detectors/carbon monoxide detectors are hardwired and interconnected. They were tested and operable. Appliances: LPA observed all kitchen appliances and washer and dryer in working order. LPA observed a 7 day supply of non perishables and 2 day supply of perishable. The residence is equipped with heat and air conditioning. Toxins: Applicant showed LPAs, where toxins to be locked/stored: In locked cabinet above washer and dryer in laundry room. Water Temperature: Tested at 110.9 degrees F. Clients & Staff Files: will all be stored in locked area in hall closet. There are no corrections needed. Component III: Conducted during today’s Pre-Licensing visit A copy of this reported provided to Licensee Rosita Matutethe state’s words, verbatim · CDSS document, Aug 23, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Nobela Punzalan CEO/ Rosita Matute Administrator Interview Method: Telephone interview On August 14, 2024, 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 that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the 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 Readinessthe state’s words, verbatim · CDSS document, Aug 14, 2024