PV Living

Type of visit: Post Licensing

On 01/14/26 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced post-licensing visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. LPA was met by staff two, Bernadeth Salvador - Caregiver (S2) and later by staff one, Tina Cinco - Administrator (S1) and the purpose of today's visit was explained. LPA verified that the facility has an approved mitigation plan report and infection control plan. There are currently 3 Residential Care Facility for the Elderly (RCFE) residents in placement. The facility's annual fees are up to date. LPA and S1 toured the facility, a single-story home located in a residential neighborhood. Entry way of the home is clear and free of debris and obstruction. There is a separate resident entrance on side of home that is accessible to the home. LPA observed a sanitation station and visitor sign-in as you enter the facility. There are 5 resident bedrooms, 3 bathrooms, dining room, living room, kitchen and an attached garage that will be used for storage and extra food items. LPA observed sufficient liquid soap, paper goods, cleaning, and disinfecting supplies. Documents are posted in the facility hallway on the bulletin board. The following Title 22 regulated areas were audited and found to be in compliance: The facility telephones are working. Bedrooms: All bedrooms meet the required standards for furniture, safety, privacy, and comfort. The facility has an adequate linen supply. Bathrooms: The bathrooms are clean and operational, and provide necessary personal accommodations with non-skid surface mats ensuring safety and privacy. Kitchen and Food Service: The kitchen is adequately equipped for food preparation and service. A review of the food service revealed an ample supply of perishable and nonperishable food, stored appropriately. Medication Storage and Management: Medications are centrally stored in a locked cabinet in the hallway with up-to-date records, ensuring proper storage and documentation. Report continues, please see LIC809-C. Common Areas: The Living room, dining room, and common areas are well maintained, free of potential hazards, and meet the cleanliness standards necessary for the safety and well-being of residents. Safety Equipment and Measures: The facility is equipped with a fully stocked first aid kit with manual, functional smoke and carbon monoxide detectors, and properly charged fire extinguishers. The hot water temperature is measured at degrees and is maintained within the standard range of 105-120 degrees Fahrenheit. Emergency Preparedness: All exit doors are in compliance, the client's bedroom windows are equipped with sliding window locks without thumbscrews. Environmental Safety: The yard is free from debris and hazards, trash cans are covered, and no firearms or bodies of water are present on the premises. Hazardous items are kept inaccessible to clients. Staff Training: Staff members have received training on reporting dependent adult and elder abuse and Cardiopulmonary . Administrative Compliance: The Administrator has successfully completed the required training. The Administrator Certificate is current and expires on 06/26/27. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with Tina Cinco - Administrator (S1) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Prelicensing

On 12/04/2025 Licensing Program Analyst (LPA) Mario Leon conducted an announced pre-licensing visit using the CARE Inspection Tool. LPA was met by staff one, Tina Cinco (S1) and the purpose of the visit was explained. An application was submitted to CCLD on June 18, 2025, for opening a new facility for an Adult Residential Care Facility for the Elderly (RCFE) to serve six (6) non-ambulatory residents aged sixty (60) and above; Hospice waiver granted for six (6). Fire clearance approved on February 29, 2025. LPA was met by Tina Cinco applicant, and explained that the purpose of today’s visit. LPA and Applicant toured the physical plant (inside and outside) with S1. The facility consists of the following: Facility is a single-story home located in a residential neighborhood. Entry way of the home is clear and free of debris and obstruction. There is a separate resident entrance on side of home that is accessible to the home. LPA observed a sanitation station and visitor sign-in as you enter the facility. There are 5 resident bedrooms, 3 bathrooms, dining room, living room, kitchen and an attached garage that will be used for storage and extra food items. The Residents' bedrooms are spacious and can easily accommodate the client's furnishings. There are two, shaded, patios in the rear and a driveway along the west-side of the house. Both sides of the house are designed for emergency exits for all non-ambulatory residents. All rooms, aside from the exit of living room, are designed for non-ambulatory residents with padded ramps. LPA observed that there are no bodies of water on the premises. The shaded area and outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Report continues, please see LIC809C. Bedrooms Residents: Bedrooms number(s) one (#1) through five (#5) have working lights, new blinds and working windows with no bars. Bedrooms #2 through #5 will be private rooms/occupied by single (1) resident and bedroom #1 will shared occupied by two (2) resident(s). Bathrooms: All Bathrooms have a working toilet, wash basins and shower, and observed to be clean, safe, and sanitary. LPA observed adequate lighting throughout the entire facility. Linens & Hygiene Supplies: Extra linens are in linen closes located in hallway next to bedroom #2, while all detergents are stored either in the kitchen or the detached garage Living room The Living room is fully furnished with sofa, one love seat and a chair, TV, lamp, covered fire place and a fully charged fire extinguisher, last serviced July 10, 2025. The dining area is equipped with six (6) seated dining chairs, cabinet and printer. Facility has a lanline phone for emergencies. There is 1 fully charged fire Extinguishers located in the kitchen area, last serviced July 10, 2025. LPA observed all required postings: See something say something, clients rights, activity schedule, emergency disaster plan, facility sketch menu (posted on refrigerator). Smoke Detectors: Facility has nine (9) 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-perishable and 2 day supply of perishable food items, stored in the kitchen. The residence is equipped with heat and air conditioning. Toxins: Applicant showed LPA, where toxins to be locked/stored either in the kitchen or the attached garage. Water Temperature: tested at 106.2 degrees F, within title 22 regulation(s). Residents & Staff Files: Resident and staff files will all be stored in locked cabinet located in the kitchen area. There are no corrections needed. Prelicensing Component III: all staff present have acknowledged awareness. An exit interview was conducted and a copy of this report has been furnished to the applicant, S1. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Dec 4, 2025

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Cinco, Tina; Fajardo Miguelito On 11/21/2025, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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 readinessthe state’s words, verbatim · CDSS document, Nov 21, 2025