Just Like You Are Home 4

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Jolina Salazar. Administrator (AD) Alicia Lira arrived shortly after. For today’s visit, LPA observed a total of six residents in care and two staff members on duty. LPA Ramirez toured the interior and exterior portions of the facility with AD Lira. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for three. The facility is a single story home with five resident bedrooms, one of which is shared, one staff bedroom, two resident bathrooms, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Two residents are currently using half-rails for postural support. Appropriate physician orders on file for the two residents. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. Bathrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 106.5-107.6 degrees Fahrenheit. LPA observed the five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. CONTINUED ON LIC809-C... Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Fire extinguishers were charged, and had a service tag dated May 15, 2026. One fire extinguisher was located by the bedrooms' hallway and one in the laundry room. LPA Ramirez observed the emergency disaster and evacuation plan, which is posted by the living room. Licensee was advised to updated the Emergency Distaste Plan (LIC610E) dated December 2025. Facility had back-up emergency food and water supply, located in the garage. LPA observed that the First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. Medications are locked in a cabinet by the dining room. Oxygen is currently in use with adequate signs on display. There are no bedridden residents present on the premises. For the exterior portion, LPA Ramirez observed a shaded patio area with furniture, and the grounds were free of any hazards. There are two gates in the backyard, which are self-closing and self-latching. No bodies of water were observed. LPA reviewed six resident files and three staff files. LPA interviewed residents and staff present. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Lira. A copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Aug 14, 2026

Type of visit: Required - 1 Year

On August 25, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Alicia Lira was notified via telephone and later arrived to assist with the inspection. LPA observed that Alicia Lira has a valid Administrator certificate which expires on December 14, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for three. The facility is a single story home with five resident bedrooms, one of which is shared, one staff bedroom, two resident bathrooms, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed six resident in care and two care giving staff present. LPA observed residents watching TV in the living room and relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all five resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 106.3 and 106.5 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C LPA observed the five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a separate locked kitchen cabinet under the sink. LPA observed fire extinguishers to be mounted on the wall in the kitchen and in the resident hallway. Fire extinguishers were observed to be charged and serviced as of May 16, 2025. LPA tested the individual smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their most recent emergency disaster drill on June 20, 2025. LPA observed the centrally stored medication to be kept in a locked kitchen cabinet. LPA observed the facility also has a First Aid Kit stored in the locked kitchen cabinet and it had all the required components. LPA observed the door leading to the laundry room to be kept locked and inaccessible to residents in care. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed chemicals and toxins to be stored in the locked garage. LPA observed incontinence supplies stored in the garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gates of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPA observed that the dosage for Resident #1 (R1) Atorvastatin 40 MG tablet medication was missing for August 26, 2025. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, a deficiency is being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Alicia Lira. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Aug 25, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Alvaro Ramirez, Jr. conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicant Stevelyn Reroma and toured the facility. An application for Change of Ownership (CHOW) to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on February 29, 2024. The facility is to have a capacity of 6 residents, (0) ambulatory, (6) non-ambulatory and (0) bedridden residents. Facility phone number 714-202-5256. LPA observed the following. Structure: The facility is a one-story house with five resident bedrooms, one staff bedroom, two full size bathrooms, a living room, a kitchen, a dining room, and an attached car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall by entryway. There are two gates in the backyard, which are self-closing and self-latching. LPA did not observe any obstacles or hazards in the backyard. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are five Resident bedrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. CONTINUED ON LIC809-C... Bathrooms: All bathrooms are clean and have working plumbing. Hot water measured between 111.9 to 115.8 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen for each resident was stored in the closet by the resident's bedroom hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Monthly menu available and posted in the kitchen refrigerator. Food Service: There are six residents living in the facility at this time. A supply of 2-day perishable and 7-day of non-perishable food was observed and will be maintained on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. Fire extinguishers were charged, mounted and one was located in the laundry room and one by the resident's bedroom hallway. Appliances: There is one, four gas burner stove which lights unassisted, one oven, one microwave, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored in the garage. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 111.9 to 115.8 degrees Fahrenheit. Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in a cabinet next to the dining room. The first aid kit has all the required elements. Medications will be stored in locked cabinet next to dining room. Resident & Staff Files: The Resident and Staff Records will be kept in a cabinet next to the dining room. Reading Material, Games, Equipment & Materials: Board games, puzzles and crossword games are stored by the dining room. There is one large screen television in the living room. Fire clearance: Fire Clearance approved by a fire inspector of Orange City Fire Department on June 03, 2024. Special conditions noted, "Fire clearance approved under the above noted conditions." Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. The applicant has met all pre-licensing requirements. LPA will submit notification to Central Applications Bureau (CAB) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Aug 9, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHANGE OF OWNERSHIP Capacity: 6 Census (if any clients in care): 4 COMP II Participants: RODA PADERNA, STEVELYN REROMA Interview Method: Telephone interview On July 09, 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 the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. 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. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 9, 2024