Amethyst Cove

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Prelicensing

On 10/16/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct the pre-licensing inspection visit. LPA initially met with a staff on duty and stated the purpose of the visit. The Licensee/Administrator, Monalisa Silapan, was notified of the visit and arrived shortly after. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents, up to 6 may be non-ambulatory, and 1 of 6 may be bedridden. Facility is cleared to accept/retain bedridden resident in bedroom #2. Facility has a waiver to accept up to 4 residents receiving hospice services. Initial Observation: Upon arrival LPA was greeted by one of the staff on duty. There were 6 residents present during this visit with 2 staff on duty. Room temperature was 72 degrees Fahrenheit. Physical Inspection: LPA toured the facility with Administrator. Areas inspected include, but not limited to, resident bedrooms, resident bathrooms, living and dining room, kitchen and outdoor areas. LPA observed 2 fire doors leading to the resident bedrooms. LPA inspected 5 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout. Bedroom #1 is a share bedroom by 2 residents. LPA measured the hot water temperature in 2 of 2 bathrooms to be 107 degrees Fahrenheit. Both resident bathrooms were observed to be clean and in good repair at this time. Exit doors have alarm. {1 of 2} Fire extinguishers were observed in the kitchen area and each of the hallways and were last inspected on 10/22/2025. Smoke and carbon monoxide detectors were observed throughout, tested and found operable at this time. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. In the kitchen area, LPA observed at least 7-day nonperishable and 2-day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Proper storage of food items was observed. Kitchen refrigerator and freezer were maintained at regulatory temperature. Garage stores additional refrigerator and freezer. Advisory was provided to switch the door knob so that it can be locked and not accessible to residents, only if they were to store chemicals and other dangerous items inside the garage. Laundry room was inspected and laundry supplies were locked. Outdoor area was inspected. LPA observed covered patio with outdoor furniture for resident use. Ramps were observed Emergency walkways were observed to be unobstructed. No bodies of water were observed. Gates and fence were observed to be in good repair. Shut-off valves were identified. Advisory was provided to licensee to ensure all staff can operate each shut-off valves, in case of emergency. Record Reviews: Facility Infection Control and Emergency Disaster Plan were reviewed. Review of 3 staff files (S1, S2, S3) included review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Licensee will not be managing residents’ cash resources. Advisory was provided for licensee to update resident and staff records as soon as the new license is received. Component III: LPA reviewed Component III with Licensee. Pre-Licensing is complete, and this facility has no deficiencies. Exit interview was conducted and a copy of the report was provided upon exit. {2 of 2}the state’s words, verbatim · CDSS document, Oct 16, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Monalisa Silapan, Applicant/Administrator Interview Method: Virtual interview (Microsoft Teams) On October 1, 2025, Applicant/Administrator participated in COMP II. Identification of the Applicant/ Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/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, Oct 1, 2025