Mountain View Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrew Martinez made an unannounced visit to the facility to conduct a required comprehensive annual inspection. LPA Martinez met with Caregiver Richard Padilla and was granted entry into the facility. LPA met with Caregiver/Designee Lindsay Jacobo and explained the purpose of today's visit. At time of visit, the facility's census was three (3), with (2) staff and (3) residents present. The facility is Residential Care Facility for the Elderly (RCFE) operating in the capacity approved by the Community Care Licensing Division (CCLD). The facility is licensed with a fire clearance for a capacity of six (6) non-ambulatory residents; the facility currently holds a hospice waiver for (2). LPA Martinez was accompanied by Caregiver/Designee Lindsay Jacobo to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is a single-story, three (3) bedroom, two (2) bathroom home with a kitchen, dining area, living room, open porches, and a detached two (2) car garage. LPA Martinez observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 78 degrees Fahrenheit. LPA Martinez inspected resident bedrooms; they are equipped with required amenities including furniture such as mattresses, lamps, nightstands, storage space, and sufficient lighting. LPA Martinez observed (1) window screen in Resident #1 (R1) room is missing. Deficiency B will be issued. LPA Martinez observed that bathrooms were clean, equipped with working toilets, wash basins, and showers with grab bars and non-skid mats. LPA Martinez observed an adequate supply of extra linens, towels, toilet paper and soaps. Hot water temperature in resident’s bathroom was measured at 109.3 and 111.3 degrees F; kitchen hot water tap measured at 107.3 degrees F. *** Continued on LIC 809C *** LPA observed a sufficient supply of hygiene items stored for residents use, night lights maintained throughout facility, and sufficient furniture for residents in care. The facility is equipped with operating combined smoke detectors and carbon monoxide alarms, as well as stand-alone carbon monoxide detectors. LPA Martinez observed auditory devices that monitor exits and alert staff. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. There was a designated storage space for resident and staff files, and locked cabinets located in the kitchen that centrally store the resident's medication. The facility has a fully stocked first aid kit, however, does not have a current, regulation approved first aid manual. A technical violation deficiency will be issued. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Refrigerator and freezers were observed to be clean and in good working condition. Care & Supervision: The facility's administrator was not present, however, caregiver Lindsay Jacobo, with designation of facility responsibility, was present throughout visit. LPA Martinez observed enough staff present and scheduled per LIC 500 to provide 24/7 care and supervision to residents in care as required for a facility with dementia residents. Record Review: LPA Martinez observed the facility's Emergency and Disaster Plans, and Infection Control Plans. LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list, and needs and services plans. LPA Martinez observed the required Pre-Admission Appraisals for (3) of (3) residents were not stored in resident's files and could not be provided to LPA during visit. Deficiency B will be issued. LPA Martinez audited (3) of (3) resident's medication against their Medication Administration Records (MARS) that revealed Resident #1 (R1) has (1) medication in which the bottle label does not reflect the exact dosage accurately per updated physician's order, and (3) of Resident #2's (R2) medications were not given or documented correctly per R2's physician order. Deficiencies A & B will be issued. LPA reviewed two (2) staff files for criminal record clearance, medical assessment/health screening reports, tuberculosis (TB) test results, required training, and First Aid/CPR certification. Staff files reviewed were observed to be complete. Based on today's observations and records reviewed, (1) type A, (3) type B, (1) TV deficiencies were cited per Title 22, Division 6, Chapter 1 of the California Code of Regulations. An exit interview was conducted where this Facility Evaluation Report (LIC 809, LIC 809C), Deficiencies & Plans of Corrections (LIC 809D), LIC 9102 and Appeal Rights were discussed and provided to Caregiver/Designee Linsday Jacobo.the state’s words, verbatim · CDSS document, Jul 6, 2026

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Prelicensing

On 5/28/2025 at 9:30 AM, Licensing Program Analysts (LPAs) Beena Singh conducted an announced visit to the facility for purpose of Pre-licensing evaluation. LPA met with Facility Licensee/President Zaldy Balanqui. An initial application to operate a Residential Facility for Elderly (RCFE)was submitted to the Central Applications Bureau (CAB) on for a total capacity of six (6) non-ambulatory. Fire clearance was granted on 1/25/25. LPA Singh observed the following: Structure: Facility is a one (1) story house with three (3) bedrooms, two (2) bathrooms, living room, dining area and kitchen. There was a two (2) car garage in the left side of the house. Heating/Cooling System: Central heating and air conditioning system installed with one (1) central panel located in the kitchen to control entire house. Bedrooms: Each client bedrooms accommodate any non-ambulatory client. All client bedrooms were adequately furnished. with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm. Bathrooms: The two (2) bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. LPA tested the water temperature in the clients' bathrooms. ***CONTINUED ON LIC 809-C*** LPA Singh verified water temperature was measured at 115 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. There was adequate seating for meals for all residents. Laundry room with washer and dryer was in the laundry room. Laundry detergents and cleaning supplies were observed in the kitchen in a locked cabinet. Living/Family room: There were two living/family room with adequate seating for all clients and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted near the main entrance. There was Let-Us-No poster, see something say something poster and Labor Laws observed. General items: Two (2) fire extinguisher were charged and located in the kitchen and hallway. Three (3) combined smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Client records and staff records will be stored in a locked cabinet in the Kitchen cabinet. First Aid kit with required components, and locked area for medication storage was observed in the kitchen cabinet. LPA Singh observed a facility phone and was operational. The phone number designated for the facility is 760-666-9195. There is enough Emergency water supply and the required 72-hour emergency food supply for clients and staffs available at the facility. Component III was completed on this day as well. Additionally, LPA Singh observed facility having Visitor Sign In/Sign Out Sheet and Client Sign In/Sign Out Sheet, upon entering facility. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Facility Licensee/President Zaldy Balanquit.the state’s words, verbatim · CDSS document, May 29, 2025