San Jacinto Assisted Living

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Seo Jeon conducted an announced visit to the facility for purpose of a follow-up Pre-Licensing inspection. LPA met with Marilou Tumaliuan, Applicant. An initial application to operate a Residential Care for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 7-22-2024 for a total capacity of 27, (12) non-ambulatory and (6) bedridden residents. Fire clearance was granted on 11-18-2024. LPA Seo Jeon observed the following: All bedrooms have the required bedding and furniture, night-stands, dressers, chairs, lighting, and emergency lighting. The bathroom appliances were operating in safe and sanitary condition. The bathrooms have non-slip surface and grab bars. Utensils and dishware are in good repair and ready for client use. Kitchen appliances and counter-top were free of debris and in good repair. The knives and sharp objects were locked in a pantry in the facility kitchen. The water temperature was measured by LPA, and the thermometer read at 113 degrees F. There is adequate seating in the common and outdoor areas. The facility has a storage locker that will hold resident files in the main office. Staff files and resident medication will be stored in a locked cabinet inside staff office next to the facility kitchen. The facility has laundry equipment and detergents in an independent building with locked gate in the backyard. An adequate supply of clean linens and hygienic supplies for the residents were readily available at the facility. There are two (3) charged fire extinguishers in the facility. LPA observed operating smoke detectors and carbon monoxide alarms in the facility. LPA observed required postings including the visitation Continued on LIC809-C.... policies, emergency/disaster plans, complaint procedures, and personal rights. The facility was equipped with a complete first aid kit and manual. LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA observed all debris removed from the backyard. LPA did not observe any resident rooms with locking door knobs. LPA observed all deficiencies from the initial inspection have been corrected. LPA has determined that the facility met the operational requirements for licensure. The Pre-licensing inspection is complete. The facility has satisfied all requirements in accordance with Title 22 California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Marilou Tumaliuan, Applicant.the state’s words, verbatim · CDSS document, Jun 16, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Seo Jeon conducted an announced visit to the facility for purpose of a Pre-Licensing inspection. LPA met with Applicant, Marilou Tumaliuan. An initial application to operate a Residential Care for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 7-22-2024 for a total capacity of 27, (21) ambulatory and (6) bedridden residents. Fire clearance was granted on 11-18-2024. LPA Seo Jeon observed the following: Structure: Facility is consisted of 3 separate buildings for residents. 397 E. Main Street has 6 resident bedrooms, 1 shower room, and 3 half bathrooms (toilette and sink only). 377 E. Main Street has 3 resident bedrooms, 1 full bathroom, and 1 half bathroom (toilette and sink only). 350 S. Alessandro Ave has 7 resident bedrooms, 1 staff room, 2 full bathrooms, and 1 half bathroom (toilette and sink only). There is 1 fenced structure in the backyard for laundry equipment with locked gate. Bedrooms: All bedrooms in 397 E. Main and 377 E. Main are for ambulatory residents only. 350 S. Alessandro Ave is approved for 10 ambulatory and 6 bedridden residents. However, fire inspection report did not specify what rooms are approved for bedridden residents for 350 S. Alessandro Ave. LPA observed resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, and adequate lighting. Some of the bedrooms did not have required furniture and they are listed at the end of this report. Continued on LIC809-C..... Bathrooms: Bathrooms in all 3 buildings have a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 93 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals for all residents. Washer and dryer were tested and operable. Laundry detergents and cleaning supplies were observed in secured laundry room inaccessible to residents. Sharps and knives need to be inaccessible to residents in care. Living/Family room: There is a living room in each building with adequate seating for all residents and TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the hallway of all 3 buildings. Yards/Outside: There is sufficient patio furniture for outdoor seating. There is no body of water in the premises. There are debris in the backyard that needs to be cleared out. General items: Total of 6 fully charged fire extinguishers are mounted on the walls of this facility. Client records will be stored in a locked cabinet. First Aid kit with required components, and locked cabinet for medication storage was observed. The facility food supply was observed to be sufficient as there was 2-day supply of perishable and a 7-day supply of nonperishable food items. The facility has an emergency food and water supply. Continued on LIC809-C.... Pre-Licensing is incomplete and the following corrections to be resolved. Applicant will advise LPA upon resolution of the following items. obtain and post required postings obtain locked storage for sharps and knives adjust hot water temperature to be between 105 and 120 degrees F install smoke alarms in all 3 buildings remove debris in the backyard remove locking door knobs and replace with passage door knobs chest of drawers for each resident remove third bed from 2 rooms in 350 S. Alessandro Ave An exit interview was conducted, and a copy of this report was given.the state’s words, verbatim · CDSS document, May 8, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 27 Census (if any clients in care): COMP II Participants: LIBERTY ALMAZAN AND MARILOU TURMALIUAN Interview Method: Telephone interview On 3/27/25], 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 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, Mar 27, 2025