Sands of Time Care Home

Type of visit: Prelicensing

On 1/7/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived announced to conduct the pre-licensing inspection visit. LPA met with Licensee, Preciousa Dayuon (S1) and Administrator, Marites Ballesteros (S2) and stated the purpose of the visit. Overview: Facility is a one-story home located in a residential neighborhood. Facility will be licensed to serve up to 6 elderly residents, up to 2 may be non-ambulatory. Facility does not have fire clearance for bedridden, delayed egress and locked exteriors. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. Outdoor Area: Front yard was observed to be maintained and clear of debris and obstruction. There is a covered patio area in the backyard equipped with outdoor furniture Outdoor passageways, walkways, driveways, and ramps are free from obstructions. Fence and gate are in good repair. No swimming pools/bodies of water at this time. Residents' Bedrooms: LPA inspected 4 of 4 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout. Each bedroom is equipped with smoke detector. Bedrooms #3 on the facility sketch (Master bedroom) is cleared for 2 non-ambulatory residents. The rest of the rooms are only cleared for ambulatory residents. The bedroom by the entrance is approved for 2 occupancies. (1 of 3) Bathroom: Facility has 2 resident bathrooms. One bathroom in the hallway and the other bathroom is inside bedroom #3. Both bathrooms have working toilets, wash basins and full baths with showers. Both bathrooms are equipped with non-skid flooring and close-lid garbage bins. Linens & Hygiene Supplies: Adequate supply of linen and hygiene supplies stored in linen closet, located in the resident hallway. Emergency Phone Numbers, Exit Plan & Menu: Emergency Disaster Plan will be posted & available for review. One fully charged fire extinguisher was observed in the kitchen/dining room. Dangerous Items: Sharp objects, toxins, and chemicals were locked/stored under kitchen sink and in the garage area. Water temperature: Hot water temperature was taken in one bathroom and measured at 115 degrees Fahrenheit. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are in locked cabinet. Smoke Detectors and carbon monoxide: Facility has smoke detectors were observed in each bedrooms and hallways. 2 carbon monoxide monitor were observed, one in the hallway leading to the resident bedrooms and one in front of bedroom by the entrance door. S1 tested one smoke detector and one carbon monoxide; both devices were working. Appliances: Stove burners and oven are in good working condition. Refrigerator/freezer temperature were within regulatory standard. Washer and dryer are located in the laundry room, leading to the garage area. Medications, First-Aid Kit & Records: First aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and manual which are stored in locked cabinet in the kitchen/dining area, available for staff use but inaccessible to residents. There is a medication cabinet that was observed to be locked. (2 of 3) Residents & Staff Files: Applicant will not be handling cash resources of residents at this time but will submit necessary documents for any changes. Activity Supplies/Materials: During this visit, LPA observed Bingo, Domino, Card Games, Puzzles Word Search. Advisory was provided for licensee to provide future residents with a variety of activities and choices. Component III: LPA reviewed Component III with S1 and S2 The applicant has passed the pre-licensing component of the application process. LPA 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 the report was provided. (3 of 3)the state’s words, verbatim · CDSS document, Jan 7, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): Method: Telephone call with CAB COMP II Participants: Dayauon, Preciosa; Ballesteros, Marites On 12/19/2025, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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, Dec 19, 2025