Signature Living on Shady River Circle

Type of visit: Required - 1 Year

On September 21, 2026, at 12:00 PM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Jerome Tecso and explained the purpose of today's visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate. The facility is licensed for six non-ambulatory residents, of which two may be bedridden. There are currently four residents who reside at this facility. The facility has an approved hospice waiver for six. The LPA Martinez toured the facility with Jerome Tecson on September 21, 2026, at 1:25 PM. LPA Martinez reviewed two resident files and one medication administration record (MAR). Resident files and MAR were kept current. LPA Martinez reviewed three staff files, and three staff files were kept current. Last fire drill was conducted on July 14, 2026. The facility has infection control plan and a disaster plan. The common facility areas were furnished and sanitary. Resident bedrooms were sanitary and furnished. Facility temperature measured at 75 degrees and water temperature measured at 105 degrees. The facility has an adequate food supply. The facility has a public telephone, and area to conduct activities. The exterior of the home is clear of debris and has a shaded patio for resident use. The exterior emergency gate is in good repair. The fire extinguishers, carbon detectors, and smoke detectors are in good repair. No deficiencies were cited at this annual inspection, and an exit interview was conducted. A copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 21, 2026

Type of visit: Required - 1 Year

On 8/21/25 at 9:30am Licensing Program Analyst (LPA) Kevin Gould arrived at Signature living on Shady River Circle for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Jerome Tecson and together conducted a tour of the home. LPA and Administrator 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 observed the fridge used to store medications needs a new lock as the lock box will not fit all medications present. LPA observed a new lock to be installed and present at the facility. LPA measured the water temperature, temperature measured at 113 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable 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. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 9020 client roster and current administrator certificate. 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, Aug 21, 2025

Allegation investigated: The facility is not financially solvent.

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to Signature Living on Shady River Circle RCFE on 2/14/25 at 2:30pm to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with staff, Jessa Macalino and together discussed the investigation details. Based on the documentation obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA requested and reviewed three months of utility bills including electricity, water and gas. LPA observed the facility is current with all utilities bills and observed a zero balance at the end of each month for all bills requested and reviewed. LPA conducted a tour of the home and observed the facility is well staffed to meet the needs of residents and is operating the facility in compliance with title 22 regulations. LPA observed plentiful food supplies for residents. The home is clean and in good repair. Report Continued on LIC 9099-C Unsubstantiated Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Financial Issues are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 14, 2025 · control 27-AS-20240917175642

Type of visit: Prelicensing

On 8/23/24 at 1:00pm Licensing Program Analyst (LPA) Kevin Gould arrived at Signature for the purpose of conducting a required pre-licensing inspection. LPA met with applicant and together conducted a tour of the home. LPA and applicant evaluated the physical plant to ensure the health and safety of future residents in care. Areas inspected are including but not limited to the kitchen, bedrooms, bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor and clean. LPA did observe four (4) window screens with small tears or worn and are in need of replacement. 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 116.6 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable 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 area secure from residents. As of todays inspection the facility has not met all requirements to be licensed. To be completed: replace/repair four (4) window screens on the back of the home. Photos of corrections to be emailed to LPA. Once received LPA will documents and refer the facility to be licensed. Exit interview conducted and a copy of this report was left with the applicant. Licensee currently operates licensed homes in substantial compliance with Title 22 regulations. Component III orientation has been waved, approved by LPA Kevin Gould.the state’s words, verbatim · CDSS document, Aug 23, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Edgar Enero CEO/Administrator Interview Method: Telephone interview On August 2, 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 the 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, Aug 2, 2024