Amistad Assisted Living and Memory Care Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with House Manager Rose Macadangdang and was granted entry to the facility. The Licensee Noelia Garica was also contacted regarding today's visit. Licensed capacity is (6) current census (2). LPA was accompanied by House Manager Rose Macadangdang to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated space for resident /staff files. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (2) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (2) resident medications and (1) hospice files. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to House Manager Rose Macadangdang.the state’s words, verbatim · CDSS document, Apr 15, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 10/8/2025. LPA Rico met with Administrator Christopher Garcia and explained the purpose of the visit. The following deficiency was cleared during the time of the visit: The Licensee was cited on 10/8/20245 for 87465 Incidental Medical and Dental Care(d)(3) . During today's visit and based on record review and interview, LPA Rico observed that the Administrator made the corrections. Therefore, the POC was cleared at today’s visit.the state’s words, verbatim · CDSS document, Oct 16, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez made an unannounced visit to conduct a Health and Safety check of the residents in care at the facility. LPA Rico met with Administrator Christopher Garcia and explained the reason for the visit. The Health and Safety check included overall observation of the facility inside, and outside, including food supply, medications, physical plant, and the residents. On 9/25/2025 the Administrator was cited for not providing proper documentation to R1's PRN medication. Today 10/9/2025 LPA Rico audit R1's medication and observed PRN medication was not documented properly. The PRN medication did not include the time, reason and result. Due to repeated violation within the 12 months, a civil penalty will be issued. In addition, the facility had documented R1's routine medication was provided, but the current medication on bubble pack did not match R1's MAR. Based on the observations made during today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809)(LIC809D)(LIC421FC) was discussed and provided to Administrator Christopher Garcia. Along with a copy of Appeal Rights and Civil Penalty.the state’s words, verbatim · CDSS document, Oct 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(d)(3) · Plan of correction due date: Oct 10, 2025

87465 Incidental Medical and Dental Care (d)(3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. Based on interviews and record review, the Administrator did not comply with the section cited above by not documenting R1's PRN which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 9, 2025

Plan of correction: The Administrator stated they will create a proper MAR medication, and organize their file. POC 10/10/2025

Allegation investigated: Facility staff left resident in soiled clothing for an extended period of time. Facility staff are not meeting residents toileting needs. Facility staff leave resident in soiled bedding. Facility staff are not assisting resident with personal hygiene. Facility staff are mismanaging resident's medication. Facility staff changed their visitor hours policy.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings regarding the allegations listed above. LPA met with Administrator Christopher Garcia and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and a review of facility records. For the allegation, Facility staff left residents in soiled clothing for an extended period of time. During staff interviews, the Administrator admitted that they had been unable to change Resident 1 (R1) for over sixteen hours. During the facility tour, LPA Rico observed R1 wearing soiled clothing. For the allegation, Facility staff are not meeting residents' toileting needs. During staff interviews, the Administrator stated they have not been able to meet residents' toileting needs. The Administrator reported that R1’s brief is only changed when hospice staff provide showers. Based on record review the facility staff are incompetent to provide care for R1, LPA found that facility staff had not completed training Substantiated related to assisting with Activities of Daily Living (ADLs) and did not have a copy of R1 care plan to meet their medical and dental needs. For the allegation, Facility staff leave residents in soiled bedding. During staff interviews, the Administrator stated that they wash residents’ bedding, it often becomes soiled again due to residents wearing soiled clothing. During the facility tour, LPA observed wet bedding and a soiled bedding in the living room couch. For the allegation, Facility staff are not assisting residents with personal hygiene. All staff interviewed stated they have been unable to assist R1 with personal hygiene due to R1’s behaviors. Based on record review the facility staff are incompetent to provide care for R1, LPA found that facility staff had not completed training related to assisting with Activities of Daily Living (ADLs) with residents with dementia. For the allegation, Facility staff are mismanaging residents' medication. During a medication audit, LPA observed that R1’s PRN medication was not documented on R1’ MAR, that would include resident’s response, reason for administration, and date/time. Additionally, LPA observed loose medication in R1’s container box without original packaging. During staff interviews, the Administrator admitted that PRN medication documentation had not been completed and were unaware of loose medication. For the allegation, Facility staff changed their visitor hours policy. During the facility tour and record review, LPA observed that the posted visitor hours were 11:00 a.m. to 5:00 p.m., which did not match the facility’s approved Plan of Operation submitted to Community Care Licensing. The original visitor hours were listed as 10:00 a.m. to 7:00 p.m. During staff interviews, the Administrator admitted to changing the facility’s visitor hours. Based on the evidence gathered during today’s investigation, the six (6) allegations listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because of the preponderance of evidence the standard has been met. During today’s visit, six (6) deficiencies was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D were discussed and provided to Administrator Christopher Garcia, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Sep 25, 2025 · control 56-AS-20250311155200

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Sep 26, 2025

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities: (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents.. personal rights: (4) To care, supervision, and services that meet...their needs. This requirement is not met as evidenced by: Based on interviews and record review, the Administrator did not comply with the section cited above by not providing care, supervision, services to meet the residents needs which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Sep 26, 2025

87468.1(a)(2) Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all.. rights:(2) To be accorded safe, healthful and comfortable.. equipment. This requirement is not met as evidenced by: Based on interviews and record review, the Administrator did not comply with the section cited above by not providing safe, healthful, and comfortable accomodations to the residents which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Sep 26, 2025

87303Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on interviews and record review, the Administrator did not comply with the section cited above by not providing clean bedding which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. POC due 9/26/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(1)(A) · Plan of correction due date: Sep 26, 2025

87705 (1)(A)Care of Persons with Dementia(1)(A)Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication,.. activities, behavioral challenges, the environment, and assisting with activities of daily living; Based on interviews and record review, the Administrator did not comply with the section cited above by not providing care, supervision, services to meet the residents needs which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff will also complete their dementia training. POC due 9/26/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(d)(3) · Plan of correction due date: Sep 26, 2025

87465 Incidental Medical and Dental Care (d)(3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. Based on interviews and record review, the Administrator did not comply with the section cited above by documenting R1's PRN which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff complete an in-service training. POC due date 9/26/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87208(a) · Plan of correction due date: Sep 26, 2025

87208Plan of Operation(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing.. Based on interviews and record review, the Administrator did not comply with the section cited above by changing visitor hours which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff post their approved visitor hours. POC due date 9/26/2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management visit pertaining to complaint control number (56-AS-20250311155200). LPA met with Administrator Christopher Garcia and explained the purpose of the visit. LPA Rico conducted a facility and review facility documents. During the visit, LPA observed cameras in the resident’s bedrooms which poses a potential health, safety, or personal rights risk to persons in care. During today’s visit,one (1) deficiency s was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report (LIC809), LIC809D, the appeal rights were discussed and provided to Administrator Christopher Garcia.the state’s words, verbatim · CDSS document, Sep 25, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87209(a)(2) · Plan of correction due date: Sep 26, 2025

87209 Program Flexibility (a) (2) A written request for a waiver or exception and substantiating evidence supporting the request shall be submitted in advance to the licensing agency by the applicant or licensee. Based on interviews and record review, the Administrator did not comply with the section cited above by not having a camera inside R1 bedroom which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: The Administrator had agreed to remove camera. Administrator also stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. POC due date 9/26/2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management visit. LPA met with Administrator Christopher Garcia and explained the reason for the visit. Community Care Licensing San Bernardino Regional Office received an Unusual Incident Report for R1. During record review, LPA Rico observed R1 incidents had occurred on 10/1/2024, 10/06/2024, 11/4/2024 and reported were to Community Care Licensing until 3/1/2025. Based on observations today visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Administrator Christopher Garcia along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Mar 14, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1) · Plan of correction due date: Mar 17, 2025

87211(a)(1) Reporting Requirements (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. Based on interview and record review, the licensee did not comply with the section cited above by not providing correct reimburstment which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 14, 2025

Plan of correction: Licensee stated they will provided a certified letter they have read and understood section 87211(a)(1).

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Christopher Garcia and was granted entry to the facility. Licensed capacity is (6) current census (1). LPA was accompanied by Administrator Christopher Garcia to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a space office for resident/staff files. Furthermore, during facility tour, LPA observed a strong odor of urine in the kitchen/dining area. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (1) resident files for admission agreements, updated physician reports, and needs and services plans. LPA audit (1) resident medications and (1) hospice file. LPA also reviewed (2) staff files for First Aid/CPR certification. During record review, LPA Rico observed the facility did not have S1 criminal clearance letter and Health Screening. In addition, S1 and the Administrator did not have staff training and dementia training documents. Furthermore, LPA Rico advised for the Administrator to receive technical support, the Administrator agreed for referral. Based on the observations made during today’s visit, (6) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Christopher Garcia. Along with appeal rights.the state’s words, verbatim · CDSS document, Mar 14, 2025

Allegation investigated: Staff did not abide to admission agreement.

Licensing Program Analyst(LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Administrator Christopher Garcia and explained the purpose of the visit. The investigation consisted of staff interviews and record review. For the allegation,Staff did not abide to admission agreement. During staff interviews, Administrator informed LPA that R1 had moved into the facility on 10/1/2024. R1’s family made a payment of 6,500 on 10/1/2024 for the month of October 2024. On 10/18/2024 R1 had moved out of the facility and personal belongs were also removed. In addition, Licensee provided reimbursement of an amount of 187.22 to R1's family. Substantiated During record review, the facility did not issue a complete reimbursement. R1’s family should receive the correct reimbursement. The reimbursement is calculated after resident’s personal property has been removed from the facility from 10/1/2024 through 10/18/2024 without charging for additional staffing. Therefore, the facility did not abide to admission agreement. Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because of the preponderance of evidence the standard has been met. During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D were discussed and provided to Administrator Christopher Garcia, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Dec 20, 2024 · control 56-AS-20241127122555

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Dec 27, 2024

1569.652(c) Termination of admission agreement upon..; removal of resident’s property; refund of fees paid.. and refund(c)A refund of any fees paid in advance ..removed from the. resident paid the fees.. personal property is .. Based on interview and record review, the licensee did not comply with the section cited above by not providing correct reimburstment which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2024

Plan of correction: Licensee stated they will send LPA proof they have provided R1's family correct reimbursement. In addition, proof they have read and understood regulation. POC due date date 12/27/2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ryan Gardner conducted an announced visit to complete the Pre-licensing inspection. LPA met with Administrator Christopher Garcia for a Residential Care Facility for the Elderly (RCFE) for six (6) non-ambulatory residents, one (1) resident may be bedridden. The fire clearance was approved by the fire department on 1/30/2024. The facility has four (4) bedrooms and two (2) bathrooms. There are four (4) resident bedrooms, a kitchen, a living room, a dining area, a laundry room, a backyard, and an attached garage. LPA toured the interior and exterior areas of the facility. The following were inspected: Resident Bedrooms: All bedrooms have the required bedding and furniture, such as clean mattresses/linens, mattress covers, nightstands, dressers, chairs, and lighting. Resident Bathrooms: The bathrooms appliances were operating in safe and sanitary condition. The water temperature was measured by LPA, the thermometer read at 115.3 degrees F. Kitchen and Dining Areas: Utensils and dishware are in good repair and ready for resident use. The kitchen appliances and countertops were free of debris and in good repair. The refrigerator was measured at 40 degrees F and the freezer was measured at 0 degrees F. The sharps were locked in the kitchen cabinet. Medication: The medications will be locked in the kitchen cabinet. Common Sitting Areas/Activities: There is adequate seating in the common areas for the residents. The facility has a supply of activities for the residents. Laundry Room/Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies were available for each resident. The laundry room contains chemicals in the cabinet. Backyard: There are no bodies of water in the backyard. There is a covered area with seating for the all the residents. All passageways were free from obstruction. Fire extinguisher, carbon monoxide, firearms: There are two (2) charged fire extinguishers in the facility. LPA observed operating smoke detectors and carbon monoxide alarms. The home does not have any firearms and or ammunition. Postings: LPA observed required postings including the visitation polices, emergency/disaster plans, complaint procedures, labor laws, and personal rights. First aid and working telephone: The facility is equipped with a complete first aid kit and manual. The facility has a working telephone for resident use. LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA has determined that the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete, and the facility has no deficiencies. The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations. The required Comp III presentation was completed. An exit interview was conducted, and this report was discussed and provided to Administrator Christopher Garcia.the state’s words, verbatim · CDSS document, Mar 7, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Interview Method: Telephone interview On 2/27/2024, 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 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, Feb 27, 2024