Wholesome Elderly on T

Type of visit: Case Management - Deficiencies

On 9/17/26 at 2:30pm, Licensing Program Analysts (LPAs) Kevin Gould and Mabel Cummings conducted a case management deficiencies inspection to address deficiencies observed while conducting a complaint investigation. LPAs observed based on observed schedules and statements obtained and staff members observed at the facility that four (4) staff members have been working at the facility with a criminal record clearance or criminal record transfer prior to being present at the facility. LPAs obtained statements from staff and residents that the facility is not disposing of used syringes according to tittle 22 and title 8 regulations. LPAs observed incomplete or missing staff files for two staff members. LPAs obtained statements from staff members present that the certified and approved administrator is not present at the facility a sufficient number of hours to provide appropriate oversight of the facility and ensure that the facility is operated within substantial compliance of regulations. Per the California Code of Regulations. Title 22, the following deficiencies are cited. An immediate civil penalty was issued during today's inspection. A copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Sep 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Sep 18, 2026

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department...this requirement was not met as evidenced by LPA review of associated staff members which revealed four (4) staff members without criminal record clearances and associated to the facility which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee shall submit an updated LIC 500 personnel report with current staff schedules and ensure all staff members listed are associated to the facility. Licensee shall also submit a written plan of correction describing the steps and processes in place to ensure all staff hired have a criminal record clearance and associated to the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(f)(2) · Plan of correction due date: Sep 18, 2026

Maintenance and Operation: Syringes and needles are disposed of in accordance with the California Code of Regulations, Title 8, Section 5193 concerning blood borne pathogens. This requirement was not met as evidenced by statements obtained from staff and resident indicating they are not disposing of used needles/syringes in accordance with title 22 and title 8 regulations which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee shall obtain an appropriate container that meets all aspects of regulations for used syringes and submit a written plan of correction identifying the steps and procedures in place to ensure the deficiency does not reoccur.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(2) · Plan of correction due date: Sep 18, 2026

Administrator - Qualifications and Duties: The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply...Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirements was not met as evidenced by numberous cirminal record clearances violations, incomplete staff and resident files observed which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee shall submit a written plan of correction identifying the steps and procedures they intend to implement at the facility to ensure the facility is operated in substantial compliance with regulations.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(a) · Plan of correction due date: Sep 18, 2026

Administrator - Qualifications and Duties: All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee shall submit an updated LIC 500 with all staff schedules and administrator. Administrator shall be present at the facility for a minimum of 20 hours per week. Administrator may also be an administrator for no more than two licensed facilities.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87205(a) · Plan of correction due date: Sep 18, 2026

Accountability of Licensee Governing Body: The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by deficiencies observed during todays inspection and statements obtained regarding administrator oversight of the facility which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee may satisfy this POC by submitting a written statement that they would like to participate in the department's Technical Support Program and completing all aspects of the technical support program.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a) · Plan of correction due date: Sep 30, 2026

The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee...This requirement was not met as evidenced by incomplete or missing files for three staff members which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2026

Plan of correction: Licensee shall ensure all staff files are complete and available for licensing to review by the POC due date 9/30/26

Type of visit: Required - 1 Year

On 6/24/26 at 2:00pm Licensing Program Analyst (LPA) Kevin Gould arrived at Wholesome Elderly on T (RCFE) for the purpose of conducting a required 1 year annual inspection. LPA met with staff member, Shay Swogger and together conducted a tour of the home. There are currently no residents in care. LPA and staff member evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 113 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 24, 2026

Type of visit: Required - 1 Year

On 06/05/25 at 8:36 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. Upon arrival it was noted that there was no one at the facility. LPA Lee called licensee Chris Faamausili to informed that LPA Lee is at the facility to conduct an annual inspection. Licensee stated that there are no residents currently residing in the home but will send a staff to let LPA Lee enter the home and conduct the annual inspection. Approximately 30 later Assistant Administrator Shay Swogger arrived at the facility and assisted with the inspection. The census is 0. This facility is licensed to served 6 non-ambulatory residents in room 1, 2, and 3. The facility second floor and detached garage are not for resident’s use. This facility also holds a hospice waiver for 6. LPA Lee along with assistant administrator Shay inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 110.2 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the common area and was last serviced on 12/18/24. Continued LIC 809-C LPA Lee observed the facility has a has a public telephone in the kitchen and the facility has the required posters posted. Facility thermostat was observed at 71 degrees Fahrenheit. LPA Lee observed toxins located in storage room and kept locked and inaccessible to residents. LPA Lee observed sharp knives kept locked in the kitchen cabinets and inaccessible to residents. The first aid kit was checked and contained the required components. LPA Lee requested staff files for review. LPA Lee reviewed 2 out of 2 staff files and they were complete. LPA Lee reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents was provided to LPA Lee during today's visit: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Shay Swogger, and a copy of these LIC 809 reports were provided to the facility.the state’s words, verbatim · CDSS document, Jun 5, 2025

Type of visit: Post Licensing

On 12/19/24, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to conduct a post-licensing visit. LPA was greeted by staff member, Juan Ramirez and explained the purpose of the visit. LPA asked that staff call the Facility Designated Administrator (FDA) Noel Estillore to inform them that CCL was present at this time. It was learned that Noel is no longer employed at the care home. Care staff then called licensee Chris Faamausili and a brief interview was conducted via telephone with the licensee Chris. LPA Lee explained the purpose of the visit. Per interview with licensee Chris will be the designated administrator. Chris also holds an active administrator certificate # 7011766740 and is valid until 06/08/2026. Licensee Chris will email LPA Lee documents to appoint himself as the administrator to the facility. Current census was 2. This facility is licensed to served 6 non-ambulatory residents in room 1, 2, and 3. The facility second floor and detached garage are not for resident’s use. This facility also holds a hospice waiver for 6. There are currently no residents on hospice at this time. LPA reviewed 2 out of 2 resident files and 2 staff files. 1 out of 1 resident file is missing appraisal and needs and service. Furthermore, 1 out of 1 staff did not have a health screening and TB. Upon arrival, LPA Lee observed a strong smell of feces in the facility. A tour of the facility was conducted. LPA Lee observed feces on resident’s toilet seat. The feces appeared old and dried. Hot water temperatures were taken to ensure it was in the regulation of 105-120 degrees and it measured at 117.1 * F. Carbon monoxide and smoke alarms were present and were in working condition. Common areas for resident use were toured. Furniture and furnishings were observed to be present and in compliance. Grab bars and non-skid mats were present and functional. Resident bedrooms were toured. Furniture and furnishing were observed to be present and in good condition. A linen closet was located in the hallway and had sufficient number of linens at this time. The kitchen area was toured. Facility freezer and refrigerator showed to be functional. Continued LIC 809-C LPA Lee observed both the refrigerator and pantry locked and made inaccessible to residents in care at this time. LPA observed 2-day perishable and 7-day nonperishable food supply and it was sufficient at this time. The fire extinguisher, located in the kitchen area, was serviced on 12/18/24 and is in compliance at this time. Second floor of the facility was toured. This facility has a centralized medication cabinet that was observed to be locked and made inaccessible to the residents. First aid kit was observed to be present and contained all the required components at this time. Toxins were observed not locked and made accessible to residents in care. Exterior grounds of this facility were toured. Perimeter fence and gates were observed to be functional and in good repair at this time. Detached garage was also toured. Per California Code of Regulations (CCR) - deficiencies are being cited on the attached LIC 809 -D. Appeal Rights provided. Failure to correct deficiencies may result in civil penalties. An exit interview was held with staff Juan Ramirez and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 19, 2024

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Prelicensing

On 06/11/2024 at 8:29 AM, Licensing Program Analyst (LPA) Pang Lee arrived announced to conduct a Pre-Licensing Inspection follow-up of the facility to ensure compliance with Title 22 regulations. LPA Lee met with licensee, Chris Faamausili who assisted in today’s inspection. Noel Estilore will be the administrator to this facility. Administrator certificate number # is 6033614740 and will expire on 02/09/2025. The facility has a fire clearance for 6 non-ambulatory residents to accept and retain at any given time. The facility will employ staff who are live-in caregivers. The facility will ensure that there is always at least one caregiver present in the facility at all times. There were no residents in care at this time. LPA Lee toured the facility with Chris and reviewed the updated facility sketch and the facility sketch aligned with the facility. During today's visit, all corrections were completed. * Licensee/Administrator will ensure that an updated plan of operation to include live in staff- Completed, on 05/31/2024, licensee emailed LPA Lee an updated plan of operation to include live in staff and expectations. · Licensee/Administrator will ensure that an updated facility sketch to include the four cameras in the home, the staircase closet, and the detached garage- Completed, on 05/31/2024, licensee emailed LPA Lee an updated facility sketch which reflected the four cameras in the home, the staircase closet and the detached garage. The up dated plan of operation also included the expectation of the cameras in the home. Continued LIC 809-C · Licensee/Administrator will ensure that the facility has sufficient supplies of hygiene for resident use- During today’s visit, LPA Lee observed sufficient supplies of hygiene for 6 residents in care. · Licensee/Administrator will endure that the facility has sufficient 7 days of non-perishable food and 2 days perishable food at all times-During today visit, LPA Lee observed sufficient 7 days of non-perishable food and 2 days perishable food for residents in care. · Licensee/Administrator will ensure that the facility has a first aid kit including a thermometer and a current first aid manual-During today’s visit, LPA Lee observed the facility had a complete first aid kit that contains the required components such as a thermometer and a current first aid manual. · Licensee/Administrator will ensure that there are activity supplies and equipment made available for residents-During today’s visit, LPA Lee observed activity supplies such as board games, puzzles, books and cards made available to residents in care at this time. · Licensee/Administrator will ensure that there is a rail install/place in the front porch to prevent residents from fall over-During today’s visit, LPA Lee observed a new rail installed in the front porch to ensure that all residents are safe from falling over the leveled porch. Applicant was advised If any changes in plan of operation or to the facility they will need to submit the updated plan of operation and an updated facility sketch and informed the department which will also need to be reviewed and approved by the Department. Component III was completed at this time with the licensee Chris. The applicant has passed the pre-licensing component of the application process. LPA Lee will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was provided to the licensee, Chris.the state’s words, verbatim · CDSS document, Jun 11, 2024

Type of visit: Prelicensing

On 05/29/2024 at 8:33 AM, Licensing Program Analyst (LPA) Pang Lee arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lee met with Licensee Chris Faamausili. Licensee assisted LPA Lee in today’s inspection. This Applicant is seeking licensure for a 6-bed non-ambulatory Residential Care Facility for the Elderly (RCFE) to accept and retain at any given time. The facility will have two live in staff. There were no residents at this time. Noel Estilore will be the Administrator of this facility. The facility administrator’s certificate # 6033614740 and will expire 02/09/2025. The facility has an infection control plan and an emergency disaster plan completed and provided to Licensing for approval. LPA Lee toured the facility, and it was learned that the facility sketch did not align with the layout of the building. It was observed that the facility has a staircase closet, four cameras and a detach garage that is not on the facility sketch. LPA Lee observed the front porch a concern to residents in care. Due to the facility seeking licensure for 6 non-ambulatory resident the front porch is a health and safety concerns because the front porch is 24 inches high, and it does not have any rails to prevent residents from falling over. LPA Lee inspected the kitchen area. Cabinets and drawers were opened and reviewed at this time. Silverware, plates, and utensils were observed to be sufficient to meet the needs of the residents at this time. Knives, cleaning agents, and bleach were observed to be locked and made inaccessible to the residents at this time. The food storage unit, facility refrigerator, was observed to be functional and in good repair at this time. Food supplies were reviewed for adequate 2-day perishables and 7-day non-perishable quantities, and they both were observed not sufficient at this time. The two-living area and dining area were observed to be furnished and sufficient to meet the needs of the residents at this time. LPA Lee observed a telephone made available to residents in the kitchen. The facility smoke detectors, carbon detectors and fire extinguisher were observed to be in good condition. The fire extinguisher was last serviced on 03/08/2024. Linen closet was observed sufficient supply of sheets, bedding, pillowcases, and blankets to meet the needs of the residents at this time. Residents’ bedrooms were toured, and furniture and furnishings were observed to be sufficient and able to meet the needs of the residents. The water temperature measured at 115.0 degrees Fahrenheit, and the facility temperature measured at 73 degrees. LPA Lee observed the centrally stored medication areas to be locked. LPA Lee inspected the first aid kit, and it was not complete. First Aid kit was missing a thermometer and a current first aid manual. LPA Lee observed there were no supply of hygiene items on the premises made available to residents in care. LPA lee observed facility has a designated area for residents and staff files, which is kept locked. LPA Lee also observed required posters posted. LPA Lee did not observe activity supplies made available for residents at this time. LPA Lee toured garage and the courtyard. LPA Lee observed the outdoor not equipped for outdoor use. LPA Lee did not observe the courtyard having any furniture made available for residents in care at this time. The emergency exit was unobstructed. · Licensee/Administrator will ensure that an updated plan of operation to include live in staff. · Licensee/Administrator will ensure that an updated facility sketch to include the four cameras in the home, the staircase closet, and the detached garage. · Licensee/Administrator will ensure that the facility has sufficient supplies of hygiene for resident use. · Licensee/Administrator will endure that the facility has sufficient 7 days of non-perishable food and 2 days perishable food at all times. · Licensee/Administrator will endure that the facility has a first aid kit including a thermometer and a current first aid manual. · Licensee/Administrator will ensure that there are activity supplies and equipment made available for residents. · Licensee/Administrator will ensure that there is a rail install/place in the front porch to prevent residents from fall over. The Applicant has not passed the pre-licensing component of the application process. The applicant will correct issues and inform LPA when the corrections have been completed. An exit interview was conducted, and a copy of this report was provided to the Applicant.the state’s words, verbatim · CDSS document, May 31, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Faamausili, Chris; Estillore, Noel - Applicant/Administrator Interview Method: Telephone interview On 05/21/2024, 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, May 21, 2024