Mc Board & Care

Type of visit: Required - 1 Year

On 9/17/2026 at 08:40 AM, Licensing Program Analyst (LPA) Matthew Aguilar made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator Maria Aguilar and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. The facility has six (6) bedrooms, two (2) bathroom home with a kitchen/dining area, and living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for six (6) non ambulatory residents, of which one (1) may be bedridden in bedroom #5 (five). The facility has two (2) hospice care waivers, and the current census is five (5) residents. The facility is also licensed to care for residents with dementia. LPA was accompanied by a staff 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 Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the 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. LPAs measured and observed the water temperatures in the bathroom to be at 119 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine closet with the resident’s medications locked. LPAs observed first aid kit and first aid book at the facility. Yards/Outside: One shaded patio with a backyard garden, one (1) side pathway on the right side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstructions. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. LPA observed that the facility has sufficient 72 hour emergency food and water. Care & Supervision: The facility has an Administrator present in the facility with enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. The facility is licensed for one (1) bedbound resident in bedroom #5. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed resident files reviewed were complete. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed staff files are complete. LPA observed that the facility completed quarterly fire and earthquake drills. LPA Aguilar reviewed three (3) resident medications and observed that Resident #1’s medication administration record was missing a signature for the last three (3) dates, which was 9/17,9/16, and 9/15/2026. Staff #2 admitted to giving the medication but forgot to sign on those dates. LPA Aguilar verified the amount of administered medication by counting the medication. It was observed that the amount of medication leftover was accurate and the staff forgot to sign for the last few days. Based on the observations made during today’s visit, one deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, and LIC809D was discussed and provided to Administrator Maria Aguilar.the state’s words, verbatim · CDSS document, Sep 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Licensee Maria Aguilar. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of whom one (1) may be bedridden in bedroom #5. Hospice waiver for two (2). During today’s inspection there were six (6) residents in care. LPA with Licensee Aguilar toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Licensee Aguilar, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed facility records. Review of resident records revealed that there was not a tuberculosis test on file for Resident #1 (R1) and Resident #2 (R2). Confidential records were stored in locked areas. [CONTINUED ON LIC809-C] One deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). An exit interview was conducted with Licensee Aguilar, to whom a copy of this report, LIC 809-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.the state’s words, verbatim · CDSS document, Oct 28, 2025

Allegation investigated: Staff are inappropriately locking in the residents while in care

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unnannounced visit for the purpose to deliver findings on the allegation listed above. LPA met with Administrator Maria Aguilar and explained the purpose of the visit. The investigation consisted of staff interviews and resident interviews. For the allegation, Staff are inappropriately locking in the residents while in care. LPA Hernandez observed a steel rod installed into front door. Administrator stated steel rod was put into top of door due to former resident breaking the door lock. LPA advised steel rod is to be removed immediately. Substantiated Based on the evidence gathered during today’s investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met. During today’s visit, one 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) was discussed and provided to Administrator Maria Aguilar along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Jun 4, 2025 · control 56-AS-20250504191752

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(6) · Plan of correction due date: Jun 5, 2025

87468.1 Personal Rights of Residents in All Facilities: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night... Based on observations, the licensee did not comply with the section cited above by not ensuring residents were being locked appropriately while in care by installing a steel rod into door, which poses an immediate health, safety, and personal rights risks to those in care.the state’s words, verbatim · CDSS document, Jun 4, 2025

Plan of correction: Licensee stated to immediately remove steel rod and seal up hole by Plan of Correction (POC) due date and submit photo documentation to LPA Hernandez.

Type of visit: Case Management - Other

On 11/15/2024 at 08:00 AM, Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Maria Aguilar to initiate a Case Management and issue Civil Penalties for the Annual Comprehensive Inspection conducted on 11/14/2024. Per records review, the facility were cited for the same regulation on 11/27/2023 for California Code of Regulation (CCR) 87705(f)(1) Care of Persons with Dementia and civil penalty will be issued today, 11/15/2024 with the amount of $250.00 for repeating the same violation within 12 -month period. In addition, the facility were cited for the same regulation on 11/27/2023 for California Code of Regulation (CCR) 87456 Evaluation of Suitability for Admission(a)(2) and civil penalty will be issued today, 11/15/2024 with the amount of $250.00 for repeating the same violation within 12 -month period. An exit an interview was conducted, where this report, LIC809, LIC421FC, and Appeal Rights were discussed and provided to Licensee/Administrator Maria Aguilar.the state’s words, verbatim · CDSS document, Nov 15, 2024

Type of visit: Required - 1 Year

On 11/14/2024 at 10:30 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. Licensee/Administrator Maria Aguilar was contacted and informed of the visit. Licensee/Administrator Aguilar arrived during the visit. LPA Brown explained the purpose of the visit to Licensee/Administrator Aguilar. The facility is a six (6) bedroom, two (4) bathroom home with a kitchen/dining area, living room, and an attached garage. The facility is licensed for a capacity of six (6) non-ambulatory residents, one resident (1) can be bedridden. The current census is five (5) residents. LPA Brown was accompanied by Licensee/Administrator Aguilar 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 Division (CCLD). There are no obstructions to interior passageway, however LPA Brown observed obstructions to exterior passageways as evidenced of broken bed, household appliances, and other woods and metals observed. Deficiency will be issued. The facility is maintained at a comfortable temperature of 73 degrees Fahrenheit. LPA Brown 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 Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the residents/staffs shared bathroom to be at 106 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were not kept inaccessible to residents in care as evidenced of two (2) sharp scissors in the kitchen drawer, not locked and accessible to residents in care. ***Continuation in LIC809C*** ***Amended Copy of LIC809** Also, LPA Brown observed Resident #4 (R4) has two (2) bottles of cleaning solutions in R4 closet, not locked and accessible to R4. Deficiency will be issued. Moreover, LPA Brown observed the facility fence side gate in disrepair. Deficiency will be issued. LPA Brown observed three (3) window screens in disrepair. Technical Violation will be issued. LPA Brown observed no non-skid mat in Resident #2 (R2) bathroom. Deficiency will be issued. In addition, LPA Brown observed no night lights maintained in hallways and passages to non-private bathrooms. Deficiency will be issued. Furthermore, LPA Brown observed that the facility added one (1) room in the living room and per documents review and staff interview, the facility did not obtain a building permit prior to the alteration made at the facility and no letter was submitted to CCLD. Deficiency will be issued. Also, LPA Brown observed first aid kit at the facility but no first aid manual approved by the American Red Cross, the American Medical Association or a state of federal health agency. Deficiency will be issued. There was a designated storage space for resident/staff files. Medications are kept inside the medication cabinet in the kitchen inaccessible to residents, however LPA Brown observed Resident #4 (R4) pre-poured medication at the facility. Deficiency will be issued. In addition, LPA Brown observed Resident #1 (R1) with half bed rail but per documents review and staff interview, R1 does not have a written order from R1 Physician indicating the need for half bed rail for mobility. Deficiency will be issued. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision: LPA Brown observed that the facility does not have a staff scheduled to work the night shift, awake and on duty as required for facility with dementia residents. Deficiency will be issued. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals, needs and services plans and centrally stored medications list. LPA Brown observed that R1, R2 and R3 do not have the required pre-admission appraisal maintained in their facility file. Deficiency will be issued. Moreover, LPA Brown observed that R2 and R3 do not have a completed Preplacement Needs and Services Plan/Care Plan (LIC625) as evidenced of missing resident/responsible party signature in R2 and R3 form LIC625. Deficiency will be issued. To add to that, LPA Brown observed Resident #2 (R2) was admitted at the facility without medical assessment/physician report signed by a physician made within last year. Deficiency will be issued. Also, LPA Brown observed that Resident #2 (R2) Physician Report does not have the required physician's primary diagnosis and secondary diagnosis. Deficiency will be issued. ***Continuation in LIC809C*** Also, LPA Brown observed Resident #1(R1) and Resident #3 (R3) Physician Report (LIC602) were incomplete as evidenced of missing ambulatory status of R1 and R3 in their form LIC602. Deficiency will be issued. LPA Brown observed that Resident #1 (R1) and Resident #2 (R2) do not have record of dosages of their medications that are centrally stored maintained at the facility. Deficiency will be issued. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA Brown observed that Staff #2 (S2) and Staff #3 (S3) do not have the required Health Screening Report. Deficiency will be issued. LPA Brown observed that S2 and S3 do not have the required Tuberculosis (TB) Test and TB Test Result. Deficiency will be issued. LPA Brown observed that S2 and S3 did not receive the required training in First Aid from persons qualified by such agencies as the American Red Cross.LPA Brown observed that S2 and S3 did not complete the required six (6) hours of dementia training before S2 and S3 work independently with residents. Deficiency will be issued. LPA Brown observed that S2 and S3 Deficiency will be issued. did not complete the required remaining six (6) hours within the first four (4) weeks of employment. Deficiency will be issued. During medication audit, LPA Brown observed that staff at the facility did not assist Resident #1 (R1) twelve (12) medications, Resident #2 (R2) three (3) medications for one (1) day and Resident #3 (R3) eight (8) medications for three (3) days and three (3) medications for eleven (11) days. Deficiency will be issued. 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), LIC809D, LIC9102 and Appeal Rights were discussed and provided to LIcensee/Administrator Maria Aguilar.the state’s words, verbatim · CDSS document, Nov 14, 2024

The state marks this report as 29 pages; the online copy we transcribed has 19. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Maria Aguilar and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE). The facility is a three (3) bedroom, two (2) bathroom home with a kitchen/dining area, living room, and an attached garage. The facility is licensed for a capacity of six (6) non-ambulatory residents, one resident (1) can be bedridden. The current census is five (5) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating within the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, and storage space. LPA found that Resident R1’s bedroom does not have a working bedroom light. The only light in R1’s bedroom was the closet light. The facility will be issued a deficiency for not having appropriate lighting in R1’s bedroom. The bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture throughout the facility. LPA measured and observed the water temperature in the bathroom to be at 106.3 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, and toxins were kept inaccessible to the residents in care. The lock for the knives under the kitchen counter is not locked and the knives were accessible to the residents in care. The facility will be issued a deficiency for not locking the knives appropriately. There was a designated storage space for resident/staff files. Medications are kept inside the hallway leading the garage inaccessible to residents. The facility has a first aid kit stored in the hallway leading into the garage. Food Service: Non-perishable and perishable food supply is sufficient for the residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed five (5) resident files for admission agreements, updated physician reports, and needs and services plans. LPA found that Resident R4 does not have an updated medical assessment/physician report. R4’s most recent medical assessment/physician report is dated 6/24/2020. The facility will be issued a deficiency for not having an updated medical assessment/physician report. LPA found that Resident R2 and Resident R3 do not have a preadmission appraisal. The facility will be issued a deficiency for not having a preadmission appraisal. LPA found that Resident R2 and Resident R3 do not have a needs/services plan. The facility will be issued a deficiency for not having needs/services plans. Medications/MARs records were audited and appeared to be dispensed and logged appropriately. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA found that Staff S1, Staff S2, and Staff S3 do not have staff files. The facility will be issued a deficiency for not having staff files. LPA found that S1, S2, and S3 do not have CPR certifications. The facility will be issued a deficiency for not having CPR certifications. LPA found that Staff S1 has been working at the facility for six (6) months without a criminal record clearance. Staff S1 admitted to LPA that for the past six (6) months they have been at the facility two (2) to three (3) times a week assisting the residents and helping S3 assist with the residents. The facility will be issued a deficiency for allowing S1 to work at the facility without a criminal record clearance. The facility will be issued a five (5) hundred-dollar civil penalty for allowing S1 to work at the facility for six (6) months without a criminal record clearance. Based on the observations made during today’s visit, eight (8) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations, along with a five (5) hundred-dollar civil penalty. An exit interview was conducted, and this report (LIC809), LIC809D forms, LIC811, LIC421BG, and the appeal rights were discussed and provided to Administrator Maria Aguilar.the state’s words, verbatim · CDSS document, Nov 27, 2023