Azalea Lane

Type of visit: Prelicensing

On 11/18/25, at 3:00pm, Licensing Program Analyst (LPA), Sommer Hayes returned announced to the above facility for purpose of a continuation of a pre-licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on 2/19/25, for an Initial license for a Residential Care Facility for the Elderly (RCFE). LPA was greeted by the applicant, Monalisa Silapan. LPA received the updated fire clearance from Cosumnes Fire Department on 11/13/25 reflecting the change in capacity from 6 to 5. Pre-licensing is complete at this time. The fire clearance has been updated, changing the capacity from 6 to 5 residents. Based on a review of this home during this Pre-licensing visit, it was determined that this facility was found to be in compliance at this time. LPA Hayes will notify the Central Application Bureau (CAB) that the pre-licensing is complete and Component III has been waived as requested by the applicant, Monalisa Silapan. An exit interview was conducted, and a copy of this report has been provided to the applicant Monalisa Silapan.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Prelicensing

On 10/27/25, at 9:00am, Licensing Program Analyst (LPA), Sommer Hayes conducted an announced inspection to the above facility for purpose of a continuation of a pre-licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on 2/19/25, for an Initial license for a Residential Care Facility for the Elderly (RCFE). The requested capacity is for 6 non-ambulatory residents. LPA was greeted and accompanied on inspection by the applicant, Monalisa Silapan. During the last visit the applicant, Monalisa Silapan was given the following list of advisories to correct. Corrected Advisories 10/27/2025 1. Applicant Monalisa Silapan has corrected room #2 to reflect a single room for one resident. This room has been changed into a single occupancy room from a double occupancy room. The room currently has one twin bed, one nightstand, one chair, one lamp and one tall dresser. 2. Bathroom #2 Applicant added a vent cover to missing bathroom vent. 3.Room #4 Extra furniture was removed in this bedroom to avoid bed from blocking exit door. 4. The backyard water hose is properly stored in a water hose stand to avoid tripping hazards. 5. No one is living in the home at this time. Personal items have been removed from the home. Cont'd on 809C 6. Since the last inspection on October 10, 2025, applicant Monalisa Silapan has obtained a valid permit for the installation of the “drywall to make partitions between 2 bedrooms” has been permitted by the City of Elk Grove on October 17, 2025. 7. Applicant completed appropriate tags and inspections for both fire extinguishers to make sure they are properly charged and ready for today’s inspection. Both fire extinguishers were tagged and inspected by Cintas on October 17, 2025. Pre-licensing is not complete at this time pending an updated fire clearance, changing the capacity from 6 to 5 residents. LPA Hayes will return at a later date to complete inspection once this has been completed. Based on a review of this home during this Pre-licensing visit, it was determined that this facility was found not to be in compliance at this time. LPA Hayes will coordinate an announced visit with applicant, Monalisa Silapan. LPA Hayes will notify the Central Application Bureau (CAB) that the pre-licensing and Component III has not been completed and not passed. An exit interview was conducted, and a copy of this report has been provided to the applicant Monalisa Silapan.the state’s words, verbatim · CDSS document, Oct 27, 2025

Type of visit: Prelicensing

On 10/10/25, at 11:00am, Licensing Program Analyst (LPA), Sommer Hayes conducted an announced inspection to the above facility for purpose of a pre-licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on 2/19/25, for an Initial license for a Residential Care Facility for the Elderly (RCFE). The requested capacity is for 6 non-ambulatory residents. LPA was greeted and accompanied on inspection by the applicant, Monalisa Silapan and Nina Menez. This home is a single-story house located in a residential neighborhood. The home has 4 bedrooms. Bedroom #1 is currently a double occupancy bedroom with a master bath and cleared for non-ambulatory residents. Bedroom # 2 is currently a double occupancy for residents and cleared for non-ambulatory. Bedroom # 3 is a single occupancy room cleared for a non-ambulatory resident. Bedroom # 4 is a single occupancy room cleared for a non-ambulatory resident. There is a total of 2 bathrooms. Resident bedrooms are located on the left and right sides of the house. In the outdoor area there was a sun room leading to the backyard, a covered patio with outdoor furniture, fruit trees and a Zen Garden. Outdoor passageways, walkways, driveways, and steps are free from obstructions. Fence and gates are in good repair. No swimming pools/bodies of water at this time. {Con't on LIC809-C} There is 1 refrigerator in the kitchen. Washer and dryer are located in a locked laundry room. First aid kits were inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and manual which are stored in locked cabinet in the kitchen area, available for staff use but inaccessible to residents. Centrally stored medications will be locked in two cabinets in kitchen. Pre-licensing is not complete at this time. LPA Hayes will return at another time when the following advisories are completed by the applicant, Monalisa Silapan. Room #2 is approved by the Cosumnes Fire for a non-ambulatory room but is not approved by LPA Hayes for two non-ambulatory residents. This room is not appropriate for two non-ambulatory residents, two dressers, two night stands and two chairs and any assistive devices. There is not enough space to safely accommodate two residents in this space. Applicant Monalisa Silapan has agreed to change this room into a single occupancy room from a double occupancy room. Bathroom #2 Applicant will add vent cover to missing bathroom vent. Room #4 Remove extra furniture in this bedroom to avoid bed from blocking exit door. Make sure backyard water hose is properly stored to avoid tripping hazards. Make sure there is no one living in the house. Personal items need to be removed from the house before the next inspection. Applicant Monalisa Silapan will follow up with River City Fire to add appropriate tags and inspections for both fire extinguishers to make sure they are properly charged and ready for the next inspection. Based on a review of this home during this Pre-licensing visit, it was determined that this facility was found not to be in compliance at this time. LPA Hayes will coordinate an announced visit with applicant, Monalisa Silapan. LPA Hayes will notify the Central Application Bureau (CAB) that the pre-licensing and Component III has not been completed and not passed. An exit interview was conducted, and a copy of this report has been provided to the applicant Monalisa Silapan.the state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none 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