TLC Home Care

Type of visit: Case Management - Health Checks

On November 20th, 2025 Licensing Program Analyst Edith Conchas made an unannounced visit to this facility to conduct a health and safety check. LPA met with Caregiver Ida Dy. During today's visit, LPA conducted a health and safety check, reviewed facility resident and did a walk-through of the facility. LPA found the following: The facility has working water and electricity still running and food available. There are only one (1) staff remaining at the facility caring for R1. Caregiver (S1) was observed cooking breakfast. S1 stated last day of working at TLC will be Sunday after R1 has moved out. LPA observed Resident 1 is still residing in bedroom five (5). R1's two (2) daughters were at facility visiting them. They stated they will start packing up R1's belongings today and will move out on or by saturday. The facility they found for R1 is at The Hills Senior Living. R1s family stated R1 had a 602 completed on 11/19/2025. And was send out to the new facility via fax from doctors office. An exit interview was conducted where this report, and appeal rights were discussed with and provided to Caregiver Ida Dy.the state’s words, verbatim · CDSS document, Nov 20, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) E.Conchas conducted an unannounced visit to this facility to conduct a health and safety check. LPA met with Manager, Cielo Mate and licensee Kelvin Mate. During today's visit, LPA conducted a health and safety check, reviewed facility records, and did a walk-through of the facility. LPA found the following: Resident 1(R1) received a notice of eviction for 60 days back in August 1st, 2025 informing they were going to be transferred to another facility. LPA requested licensee to amended that to the correct verbiage based on title 22 regulations on evictions. LPA observed three out of the four residents were relocate and transferred to RCFE facility called Pacific Pines at 1438 Pacific St. Redlands CA 92373 on October 30th, 2025. Resident 1 was moved to bedroom five (5) from previous bedroom three (3). There are only 2 staff remaining at the facility caring for R1 which is S1 and Kelvin Mate. On 11/5/2025 in the evening around 6:30 pm, licensee was physically handed a form by the landlords brother-in-law (W1) a notice to vacate the premise or pay rent within 48 hours. Licensee will update R1 on the notice to vacate received on 11/6/2025. LPA asked licensee what the plan is for R1 and their facility. Licensee will assist R1 to find a facility to transfer out and will prorate from the $5000 charged for the month of November from the date R1 leaves the facility. Licensee will also call local ombudsmen regarding the situation and update the CCL regarding status of R1 relocation An exit interview was conducted where this report, LIC809, and were discussed with and provided to Licensee Kelvin Mates.the state’s words, verbatim · CDSS document, Nov 6, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michelle Echeverria conducted an unannounced case management visit to this facility to deliver findings after discovering information after an annual inspection. LPA met with Administrator/Licensee, Kelvin Mate . During today's visit, LPA reviewed facility records, did a walk-through of the facility and interviewed a resident. LPA found the following issues: Administrator/Licensee overcharged monthly fees to resident 1 (R1): Administrator/Licensee charged ($10,000.00) for room & board on 09/28/2025 for the months of November 2025- December 2025 after an eviction date of 09/30/2025. Administrator/Licensee did not provide a minimum 60 days eviction written notice to all of the residents. These poses an immediate and potential health and safety risk to resident in care. Refer to LIC 809D for deficiency cited. An exit interview was conducted where this report, LIC809D, and appeal rights were discussed with and provided to Administrator/Licensee, Kelvin Matethe state’s words, verbatim · CDSS document, Oct 30, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.655(a) · Plan of correction due date: Oct 31, 2025

15669.655(a) Increase in fee rates for elderly residents; 90 days' written notice standing amount of reasons for increase; application of section: (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes..of the resident. This requirement is not met as evidenced by: Based on observation, interviews, and records review, the administrator/licensee did not comply with the section cited above by overcharging R1 $69,600.00 and not providing a rate increase written notice which poses an immediat health, safety and personnal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Administrator/Licensee stated that he will issue a check of $10,000.00 to R1's by POC due date and will submit proof of transaction to LPA via email by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.682(a)(2) · Plan of correction due date: Nov 4, 2025

1569.682(a)(2) Transfer of resident upon forfeiture of license or change in use of facility; duties of licensee; closure plan; duty of department upon licensee’s failure to comply; civil penalties: (a) A licensee of a licensed residential.. the following:(2) Provide each resident..all of the following: This requirement is not met as evidenced by: Based on observation, interviews, and records review, the administrator/licensee did not comply with the section cited above by not providing a timely eviction notice to all the residents which poses a potential health, safety and personnal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Administrator stated that he will provide a valid written eviction notice to the residents and submit a plan of action to LPA via email by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Caregivers, Adelaida Dy and Doroteo Zapanta and introduced self and stated purpose of the visit. LPA phone called Licensee/Administrator, Kelvin Mate and informed him about the purpose of the visit. LPA was informed that there are currently 4 residents in care who are in the facility. The facility has 4 resident bedrooms, 3 resident bathrooms, kitchen, dining area, living room, laundry room, attached garage, and backyard with a shed. LPA completed a walk through of facility, and review of records. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperature tested at 139 degrees fahrenheit without warning signs posted. Deficiency issued. The facility is equipped with operational smoke detectors, carbon monoxide alarms, fire extinguisher and first aid kit. Posters such as; the personal rights, ombudsman, and license were posted in a common area. LPA also observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed secured and inaccessible to residents. There are no guns or ammunition in the facility. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with self-latching handle on the left side of the house that leads into the backyard, 1 shed used for storage and 1 covered and inaccessible hot tub. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed all resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed that the administrator did not have complete resident records: incomplete admission agreements, no preappraisals, no revised appraisals, no updated medical assessments. Deficiency issued. LPA observed that the administrator did not have fire clearance for 1 resident out of the 3 residents who are diagnosed as nonambulatory per their medical assessment. Deficiency issued with civil penalty. LPA observed that the administrator did not have fire clearance for one resident who is diagnosed as bedridden per their medical assessment. Deficiency issued with civil penalty. LPA also reviewed personnel and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed that the administrator did not have complete personnel records for two staff: LIC501 and LIC503 missing. Deficiency issued. Medications was not audited due to time management. LPA reviewed the facility's insurance coverage, emergency disaster plan, infection control plan and emergency drills. LPA observed that the administrator did not have a copy of a reviewed/updated infection control plan. Deficiency issued. LPA observed that the administrator did not have a Plan of Operations. Deficiency issued. LPA observed that the administrator did not have proof of a liability insurance. Deficiency issued. LPA observed that the administrator did not have proof of an emergency disaster plan. Deficiency issued. LPA observed that the administrator did not have proof of emergency drills conducted. Deficiency issued. Deficiencies and civil penalties were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC421IM and appeal rights were discussed and copies were provided to the administrator/licensee Kelvin Mate.the state’s words, verbatim · CDSS document, Oct 29, 2025

Allegation investigated: Licensee is being evicted from property due to non-payment of rent.

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver findings for the mentioned allegation. LPA met xxx who was informed of the purpose of the visit and allegation. The investigation consisted of interviews with Landlord, outside party, Licensee, and review of documents. LPA Allen conducted interviews with the licensee, an outside party, and the property's landlord. All parties confirmed that a 3-Day Notice to Pay Rent or Quit, covering the period from December 10, 2024, to January 9, 2025, was issued and received on December 16, 2025. The investigation also revealed that the payment for the aforementioned period was deposited into the landlord's account and the landlord has confirmed as received. The licensee provided documentation of payments made with certified funds into the landlord's account over the past three months. Additionally, the landlord, tenant, and outside party stated that no official notice of eviction has been issued to the renters as of February 2025 for the period specified in the 3-Day Notice. Unfounded Based on interviews and evidence gathered during the investigation, the above allegation is found to be Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.. An exit interview was conducted where this report was discussed and provided to Maria Cielo Mate- Caregiver at the conclusion of the visit with appeal rights.the state’s words, verbatim · CDSS document, Feb 26, 2025 · control 56-AS-20250127153220

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to conduct an annual inspection. At the time of the visit there were two (2) staff members and six (6) residents. LPA met with Adelaida Dy who was informed of the purpose of the visit and she assisted with the tour of the facility. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 73 degrees. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. The water was measured at 105-120 degrees. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors, fully charged fire extinguisher, and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. LPA observed there was a designated storage space for resident/staff files. Medications are kept locked inaccessible to residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans which were not up to date. The licensee has agreed to update Resident 1, Resident 2 and Resident 3 files with current needs and service plans, physicians reports and updated emergency information sheet. LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, there was no current training's on file for staff members Staff 1 and Staff 2. The licensee has agreed to provide training to staff members and provide proof of training once completed. Based on the observations made during today’s visit, deficiencies were cited. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. An exit interview was conducted, and this report was discussed and provided to Adelaida Dy- Support staff at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 19, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA's) Bernadette Allen made an unannounced visit to the facility to conduct an annual inspection. At the time of the visit there were Two (2) staff members and six (6) residents. LPA met with Adelaida Dy who was informed of the purpose of the visit. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: The Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient furniture and lighting and is maintained at a comfortable temperature. There was enough nonperishable and perishable food for the number of residents in care. The facility has a variety of food available for residents, and a menu was available for review. The facility food is stored in a safe and healthful manner. Sharps are stored and locked cabinet inaccessible to clients in care. The resident’s bedrooms are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting. All bathrooms were operating in a safe and sanitary conditions. The hot water temperature measured between 105- and 120-degrees F. LPA also observed the facility is equipped with operating carbon monoxide/smoke detectors and fully charged fire extinguishers. Posters such as personal rights and the disaster plan were posted in a common area. LPA did observe cleaning supplies, toxins items are kept in a locked cabinet on the porch back inaccessible to clients in care. The resident’s files were reviewed, and all files had the required documents at the time of the visit. The staff files were missing current and past training's a Technical Advisory (TA) has been cited for licensee to have training documents available for review by 12/11/2023. An exit interview was conducted with Adelaida Dy where this report was discussed will be emailed to the licensee by the end of the day.the state’s words, verbatim · CDSS document, Nov 27, 2023

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.