Tender Loving Care Guest Home

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced case management visit-Legal/non-compliance visit. LPA Serrano identified himself and was granted entry by licensee/operator Victoria Legaspi. LPA met with licensee/operator Legaspi and discussed the purpose of today’s visit. LPA was immediately informed by Licensee that the facility no longer had residents in care. During today’s visit, LPA Serrano was escorted throughout the facility. LPA inspected each room and the outside perimeter and confirmed that their were no residents in care. Licensee stated that she was advised by the resident's case worker that Resident #1 and Resident #2 were transferred to Carroll's Residential Care and Resident #3 remains at the hospital. No deficiencies were cited or observed on this date. An exit interview was conducted, and a copy of this report was given to Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit-Legal/non-compliance visit. LPA Lopez identified herself and was granted entry by licensee/operator Victoria Legaspi. LPA met with licensee/operator Legaspi and discussed the purpose of today’s visit. During today’s visit, LPA Lopez spoke with licensee/operator Legaspi and resident #1 (R1). LPA verified residents' health and safety, and spoke with licensee/operator Legaspi. LPA confirmed that Ms. Victoria Legaspi was still operating the home as a facility, and three residents still lived at this address. During the visit, LPA provided R1/tenant with the LIC 986 letter as they were onsite. Per Victoria Legaspi, resident #2 (R2)/tenant was out at their day program and would not return until midafternoon, around 3:30 PM; and resident #3 (R3)/tenant was currently being seen at a local hospital. LPA provided Ms. Legaspi with a hard copy of the LIC 986 for R2 and R3 for their review. LPA also provided Ms. Victoria Legaspi a Notice of Operation in Violation of the Law (NOV) letter informing Victoria Legaspi that they are operating without a license. Prior to LPA's exit, LPA removed the license from the facility. An exit interview was conducted, and a copy of this report and the NOV letter were provided to operator Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Mar 19, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management Visit. LPA was greeted by and met with Licensee Victoria Legaspi, to discuss the purpose of the visit. On 03/03/2026, Licensing Program Analyst (LPA) Ramon Serrano conducted a follow up visit to the facility regarding information received that the facility had been without a working phone for several days. The licensee had informed the Department on 02/27/2026 that the facility’s phone service had been disconnected due to nonpayment. During the follow up visit, the licensee confirmed to LPA Serrano that the phone had been disconnected but was reconnected on 2/27/26. LPA reminded the licensee that a working phone must be available at all times so staff, residents, and emergency services can reach the facility during urgent situations. LPA advised the licensee that being without a working phone for several days poses a health and safety risk to residents in care. The licensee stated they understood the requirement and agreed to ensure it remains operational going forward.Due to the previous incident involving lack of phone access, a deficiency was cited under Title 22 regulations. The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Victoria Legaspi. A copy of this report, along with Licensee/Appeal Rights (LIC9058 3/22) was provided to Victoria Legaspi. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Mar 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87311 · Plan of correction due date: Mar 4, 2026

All facilities shall have telephone service on the premises... Based on information received and interview, the facility did not comply with the requirement to maintain a working telephone. Failure to maintain an operational phone poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: The licensee stated that the phone was reconnected on 2/27/26. LPA visually inspected the phone/landline and called the facility landline to verify that it was operational. The POC was cleared on 3/3/26.

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit-Legal/non-compliance visit. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of today’s visit. During today’s visit, on 01/23/2026, Licensee worked on the notices as described in HSC, Section 1569.38, Posting of licensing reports; disclosure to new resident, and before LPAs exit, LPA confirmed Licensee Legaspi spoke with the residents, their representatives and the LTCO regarding the facility closure due to revocation of facility license and informed them that a written notice is forthcoming. An exit interview was conducted, a copy of this report, along with Licensee Rights (LIC 9058 03/22) were provided to licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 23, 2026

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit-Legal/non-compliance visit. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of today’s visit. On 01/15/2026, the Department visited the facility for a legal/non-compliance visit. During the visit, LPA Lopez met with Licensee Legaspi, who confirmed they were in receipt of documents informing them of administrative action by the Department to revoke the facility's license. LPA Lopez printed and reviewed Health and Safety Code (HSC), Section 1569.38, Posting of licensing reports; disclosure to new resident. LPA reviewed posting and notification requirements that must be completed by 01/19/2026 (10-days of receipt of documents) to residents, their responsible parties, and the Long-Tern Care Ombudsman, and that failure to follow the requirements stipulated on the HSC would result in the assessment of further civil penalties. During today’s visit, on 01/23/2026, LPA spoke with Licensee Legaspi and confirmed they did not notify residents, their responsible party (RP), or the Long-Term Care Ombudsman (LTCO), in writing, regarding their revocation of licensure. Therefore, civil penalty of $100 per day is being assessed per HSC, 1569.38, commencing, 01/20/2026 through 01/23/2026, for 4 days [$100 per day, until the requirement is met or the maximum penalty of $5,000] totaling to $400. During the visit, the Licensee worked on the notices as described in HSC, Section 1569.38, and before LPAs exit, LPA obtained a copy of the notifications to the residents, their RPs, LTCO, and confirmed of the posting of the revocation of licensure was posted in a visible area of the facility. (Continuation on LIC809-C) (Continuation of LIC809) There are deficiencies observed and cited during today’s visit, and may be reviewed on the LIC809-D and LIC421 page of this report. An exit interview was conducted, a copy of this report, civil penalty (LIC421), along with Licensee Rights (LIC 9058 03/22) were provided to licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 23, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(g) · Plan of correction due date: Jan 19, 2026

1569.38 Posting of licensing reports; disclosure to new residents: A licensee who fails to comply with the requirements of subdivision (b) or (c) shall be liable for civil pemalties ... this requirment was not met as evidence by: Based on interview with the licensee and records reviewed, the licensee did not notify the residents or their RPs of the revocation of the facility license as required which violated the residents personal rightsthe state’s words, verbatim · CDSS document, Jan 23, 2026

Plan of correction: This requirement was met during the visit and is deemed cleared.

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analysts (LPA’s) Carmen Lopez and Jose De La Cruz conducted an unannounced case management visit-Legal/non-compliance visit. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPAs met with Licensee Legaspi and discussed the purpose of today’s visit. During today’s visit, LPA’s Lopez and De la Cruz toured the facility, requested and obtained relevant documents, spoke with residents and verified their health and safety, and spoke with Licensee Legaspi. LPAs confirmed that Licensee received the documents and understood their contents. LPA’s explained to Licensee Legaspi, the expectations of their daily operations henceforth. An exit interview was conducted, a copy of this report, along with Licensee Rights (LIC 9058 03/22) were provided to licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Carmen Lopez and Jose De La Cruz made an unannounced visit to conduct a continuation for a Required Annual Inspection that was commenced on 10/20/2025. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with licensee Victoria Legaspi. Due to technical difficulties and time constrains, the annual inspection is being continued on today's date. During today's visit, LPA's Lopez and De La Cruz continued the annual inspection and provided the licensee with the resulted findings. Deficiencies and civil penalties are being cited during today's visit and may be reviewed on the LIC809-D and LIC421 pages of this report. An exit interview, and POCs were jointly developed with Licensee Victoria Legaspi to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit. Signature below serves as confirmation of receipt of these documents.the state’s words, verbatim · CDSS document, Oct 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Oct 24, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in 1 out of 3 staff was not associated to the facility roster, which poses an immediate safety risk to 5 out of 5 persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: The licensee will submit staff documentation to RO to associate staff, and CC LPA, by POC due date, 10/24/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Oct 23, 2025

(a) Except as specified in subsection (b), the licensee shall ensure that ... knives,... which could pose a danger to residents are in locked storage and are ...outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in five out of five sharp objects (knife, cutter, cleaver knives, scissors) which poses an immediate health, safety or personal rights risk to 5 out of 5 persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: The licensee locked away the sharp objects during the visit.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(f)(2) · Plan of correction due date: Nov 6, 2025

(f) A facility shall have both of the following in place: (2) A set of keys available to facility staff on each shift for use during an evacuation that provides access to all of the following: This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in two out of two facility keys which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Obtain a second copy of the facility keys for bedroom number 3 and backyard shed by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(a) · Plan of correction due date: Nov 6, 2025

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement was not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above in two out of three persons which poses/posed a potential health, safety and personal rights risk to five out of five persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: The licensee agrees to get another person to help 10 hours a week, get their documents and associate them to the facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b)(15) · Plan of correction due date: Oct 23, 2025

(b) Each resident's record shall contain at least the following information: (15) The admission agreement ..l. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in two out of five residents which poses/posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Licensee agrees to add the admissions agreement to the residents’ files and send the signed document to LPA by POC.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(f)(1) · Plan of correction due date: Oct 23, 2025

(1) The name, address, and telephone number of each resident's physician and dentist shall be readily available to that resident, the licensee, and facility staff. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in five out of five residents which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Licensee agrees to reach out to the residents case managers and ask if the residents have a dentist assigned, if not, ask case managers to assign one. Send the updated facesheet by POC.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Nov 6, 2025

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in one out of three staff members which posed a potential health and safety risk to five out of five persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Licensee agrees to send a copy of the LIC503 and TB est to LPA by POC

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a)(1) · Plan of correction due date: Nov 6, 2025

(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.This requirement was not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in two out two cases which posed a potential health, risk to five out of five persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Licensee agrees to clean the residence to address the odor as well as the spider webs found on the hallway by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Nov 6, 2025

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional ...to be kept in the resident's record. This requirement was not met evidenced by: Based on record review, the licensee did not comply with the section cited above in five out of five persons in care, which poses a potential health, safety and personal rights risk to five out of five persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Licensee agrees to schedule the medical appointments for all residents and submit the medical appointment schedule to LPA by POC.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst’s (LPA’s) Carmen Lopez and Jose De La Cruz conducted an unannounced required annual inspection and, in conjunction conducted this case management visit for a Plan of Correction (POC) clearances. LPA Lopez and De La Cruz identified themselves and were granted entry by Licensee Victoria Legaspi. LPA's met with Licensee Legaspi and discussed the purpose of today’s visit. During today’s visit, LPA’s Lopez and De la Cruz spoke with the Licensee Legaspi. According to licensee Legaspi, none of the pending POCs have been corrected with the exception of one. On 10/20/25, LPA Lopez reissued a citation that was cleared during today’s visit for CCR Section 87468.1 (a)(1) Personal Rights of Residents in all Facilities, that was issued on 08/25/25. This is deemed cleared during today’s visit. The following deficiencies were formerly issued and have continued as civil penalties for the following uncleared deficiencies: On 05/19/2025, Licensee was issued a citation for Plan of Operations and Reporting Requirements. During today’s visit, the Licensee was unable to produce the documents to clear the citations and civil penalties have been assessed. On 04/24/2025, licensee Legaspi was issued citations for staff training for resident Bill of Rights, Resident Records, Evaluation of Suitability for Admission, Basic Services, Finances, and Health and Safety Code (HSC) for quarterly fire drill, and evacuation chair, and deficiencies were discussed with the Licensee. LPA’s Lopez and De La Cruz confirmed the deficiencies have yet to be cleared and civil penalties will continue to accrue. A failure to correct was issued for each of the deficiencies. (Continuation on LIC809-C) (Continuation of LIC809) On 04/17/2025, the Licensee was issued a Type A deficiency regarding false/misleading statements. On 08/25/2025, Licensee was unable to produce the POC to clear the deficiency. During today’s visit, the Licensee was still unable to produce the POC, and a failure to correct was issued for the continued deficiency. On 10/28/2024, licensee Legaspi was issued citations that continued to civil penalties up to date for resident reappraisals, client #1 (C1’s), Personnel Records for staff #1 (S1) and Administrator’s certificate as licensee Legaspi was unable to produce the clearance. Civil Penalties continue to accrue for these citations issued on 10/28/2024. Also, on today's date licensee will be issued a repeat violation for resident records - specifically Physician's Report (LIC602) on their required annual inspection. On 12/05/2024 and 12/06/2024, the Licensee was issued civil penalties for a visit conducted on 10/28/24, for Personnel Records, Resident Records, and reappraisals. During today's visit, the Licensee was issued civil penalties as the deficiencies issued on 12/05/2024 and 12/06/2024 have yet to be corrected. During today's visit, LPAs did leave the facility to write their reports and returned to deliver their findings regarding today's visit. An exit interview was conducted, a copy of the Failure to Correct/Civil Penalties, and a copy of this report, along with Licensee Rights (LIC 9058 03/22) were provided to licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Oct 20, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 24, 2025

87468.1 (a)(1) Personal Rights of Residents in all Facilities: To be accorded dignity in their personal relationships with staff, residents, and other persons... This was not met as evidence by: Based on interviews with residents and staff, staff did not address the indecent exposure incident for 2 of 4 residents in care when they were informed which posed a potential personal rights risk to 2 of 4 residents in care.the state’s words, verbatim · CDSS document, Oct 20, 2025

Plan of correction: Licensee agreed to move one of the residents to a different room to ensure the incident is not repeated by POC due 5/30/25, but both clients agreed to stay as roommates. As such the POC was re-evaluated and residents signed an agreement which was completed during today’s visit and deemed cleared.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Carmen Lopez and Jose De La Cruz made an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with licensee Victoria Legaspi. LPAs arrived at the facility at 9 am. According to the facility’s administrator, the facility has a maximum capacity for six (6) clients, 60 and above, none of which can be non-ambulatory. The facility currently has five (5) residents in care, all of whom are ambulatory. At 9:00 am, LPAs entered the living room, where a bottle of medication, Chloridine HLC for Victoria Legaspi was observed in one of the tables. At 9:05, resident files were reviewed by LPA. At 9:44 am, LPA’s requested staff files, but licensee was busy preparing residents’ meals, in the meantime, LPA took a walk around living room where he found square diapers on the floor, PPE, etc. There is some clutter with boxes in the living room, two vacuum cleaners and fire alarms in boxes. There was a fire extinguisher next to the kitchen that was checked recently. At 10:05 am, LPA interviewed R3 and at 10:10 am R2. At 10:23 am while walking outside, LPA observed furniture on the outside as well as two (2) mattresses and two (2) commodes. At 10:54 am LPA reviewed facility staff files. At 11:34 am, LPA was on R1 and R4’s room. At 11:35 am, LPA was on the restroom where water temperature reached 113.5 F. At 11:40 am LPA was with Licensee at the back yard, where there was a locked shed, to which licensee did not have a key, and a 2-3 inches hole was observed close by. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC809] At 11:48 am, LPA and Licensee were in the kitchen, where water reached out 117F. A seven inches cutter was observed in one drawer and a twelve inches knife and two (2) twelve inches cleaver knives were observed, along with scissors. At 12:01 pm, LPA observed spider webs in the hallway as well as vents. At 12:02 pm, Licensee disclosed that bed on second living room is used by S3. A continuation visit will need to be conducted to finalize the annual inspection as time did not permit for the completion of today's visit. Deficiencies will be cited during continuation Deficiencies will be cited, and jointly developed with licensee Legaspi, at the continuation due to technical difficulties. An exit interview was conducted with Licensee, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit. Signature below serves as confirmation of receipt of these documents.the state’s words, verbatim · CDSS document, Oct 20, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst’s (LPA’s) Carmen Lopez and Jose De La Cruz conducted an unannounced case management visit for a Plan of Correction (POC) clearance. LPA Lopez and De La Cruz identified themselves and were granted entry by Licensee Victoria Legaspi. LPA's met with Licensee Legaspi and discussed the purpose of today’s visit. During today’s visit, LPA’s Lopez and De la Cruz spoke with resident and with Licensee Legaspi. According to licensee Legaspi none of the pending POCs have been corrected. On 08/25/25, LPA’s continued civil penalties for citations on Plan of Operations reissued on 05/19/2025. On 05/19/2025, Licensee was issued a citation for Personal Rights of Residents in all Facilities which was due on 5/30/25. As the citation lapsed, LPA reissued the citation during today's visit. On 4/24/25, Licensee was issued deficiencies for not having fire drills and evacuations chairs, due 05/23/25. During today’s visit, LPA confirmed that the licensee did not have their POC cleared. Civil Penalties are being issued for the deficiencies that were not cleared. On 10/28/2024, licensee Legaspi was issued citations that continued to civil penalties up to date for resident reappraisals, client #1 (C1’s) Physician’s Report (LIC602), Personnel Records for staff #1 (S1) and Administrator’s certificate as licensee Legaspi was unable to produce the clearance. On 04/17/2025, the Licensee was issued a Type A deficiency regarding false/misleading statements. On 08/25/2025, Licensee was unable to produce the POC to clear the deficiency. During today’s visit, the Licensee was still unable to produce the POC, and a failure to correct was issued for the continued deficiency. (Continuation on LIC809-C) (Continuation of LIC809) On 04/24/2025, licensee Legaspi was issued staff training for resident Bill of Rights, Resident Records, Evaluation of Suitability for Admission, Basic Services, Finances, and Health and Safety Code (HSC), quarterly fire drill, evacuation chair, and Finances, were discussed with the Licensee. LPA’s Lopez and De La Cruz confirmed the deficiencies have yet to be cleared and civil penalties will continue to accrue. A failure to correct was issued for each of the deficiencies. On 12/05/2024 and 12/06/2024, the Licensee was issued civil penalties for a visit conducted on 10/28/24, for Personnel Records, Resident Records, specifically medial assessments, and reappraisals. During today's visit, the Licensee was issued civil penalties as the deficiencies issued on 12/05/2024 and 12/06/2024 have yet to be corrected. An exit interview was conducted, a copy of the Failure to Correct/Civil Penalties, and a copy of this report, along with Licensee Rights (LIC 9058 03/22) were provided to licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Aug 25, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Sep 8, 2025

87468.1 (a)(1) Personal Rights of Residents in all Facilities: To be accorded dignity in their personal relationships with staff, residents, and other persons... This was not met as evidence by: Based on interviews with residents and staff, staff did not address the indecent exposure incident for 2 of 4 residents in care when they were informed which posed a potential personal rights risk to 2 of 4 residents in care.the state’s words, verbatim · CDSS document, Aug 25, 2025

Plan of correction: Licensee agreed to move one of the residents to the a different room to ensure the incident does not repeat by POC was due 5/30/25, but both clients agreed to stay as room mates. As such the POC was reevaluated and residents will sign an agreement and be sent to LPA via email by POC due date 9/8/25.

Type of visit: POC

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit for a Plan of Correction (POC) clearance. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of today’s visit. On 5/19/25, Licensee was reissued citations for Plan of Operations and Reporting Requirements with a due date of 05/26/2025. A plan of correction (POC) was jointly developed with the licensee Legaspi. During today’s visit, LPA confirmed that the licensee did not have their POC for their Plan of Operations and a civil penalty will be issued during today’s visit. The licensee was able to produce the POC for Reporting Requirements, during today’s visit. A civil penalty is still being issued for the time elapsed between 5/26/25 through 05/28/25. On 4/24/25, Licensee was issued deficiencies for not having fire drills and evacuations chairs, due 05/23/25. A POC was jointly developed with licensee during the time of the visit. During today’s visit, LPA confirmed that the licensee did not have their POC cleared during today’s visit. Civil Penalties are being issued for the deficiencies that were not cleared. Also, on 4/24/25, the Licensee was issued multiple deficiencies regarding staff training, residents' functional capabilities assessments, residents' pending medical assessments, activities for residents, and facility financial records. (Continuation on LIC809-C) (Continuation of LIC809) At the time of the visit, Resident Records, Evaluation of Suitability for Admission, Basic Services, Finances, and Health and Safety Code (HSC), Section 1569.267 Resident’s Bill of Rights, were discussed with the Licensee. A POC was jointly developed with Licensee. Civil Penalties were issued for the deficiencies not being cleared. During today’s visit, LPA confirmed the deficiencies have yet to be cleared and civil penalties will continue to accrue. A failure to correct was issued for each of the deficiencies. On 04/17/2025, the Licensee was issued a Type A deficiency regarding false/misleading statements. At that time, CCR, Section 87207, was discussed with licensee Legaspi. A POC was jointly developed with Licensee with a due date of 4/18/25. On 4/24/25, Licensee was unable to produce the POC to clear the deficiency, and a failure to correct. During today’s visit, the Licensee was still unable to produce the POC, and a failure to correct was issued for the continued deficiency. On 12/05/2024 and 12/06/2024, the Licensee was issued civil penalties for a visit conducted on 10/28/24, for Personnel Records, Resident Records, specifically medial assessments, and reappraisals. During today's visit, the Licensee was issued civil penalties as the deficiencies issued on 12/05/2024 and 12/06/2024 have yet to be corrected. An exit interview was conducted, and a copy of this report, along with Licensee Rights (LIC 9058 03/22), and the civil penalties issued were provided to Licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, May 29, 2025

Allegation investigated: Licensee did not address resident-on-resident indecent exposure

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced visit and,for a complaint investigation visit to deliver findings. LPA identified herself and was granted entry by Victoria Legaspi, Licensee. LPA stated the purpose of the visit and reviewed the findings of the complaint with Licensee Legaspi. The Department’s investigation consisted of interviews with staff, residents and our side sources, and records review of relevant documents pertinent to this investigation. On April 10, 2025, it was said Licensee did not address resident-on-resident indecent exposure. It was specifically alleged that resident #1 (R1) was exposed to indecent exposure by resident #2 (R2) on multiple occasions, and the Licensee was aware and did not address the issue. Interview with an outside source #1 (OS1) said that since R1 had certain underlying medical conditions, they did not know if the allegations were truthful. Substantiated They mentioned that R1 did report to their specialized practitioner, and it was at this time, they were informed regarding the incident. When they spoke with R1, they mentioned to OS1, R2 had masturbated in their room. Interview with the Licensee confirmed that they were informed regarding the indecent exposure incidents. The licensee mentioned they believed that since R1 wanted their own room, they felt it was the reason they had told them about the incidents, and believed that their underlying medical conditions had something to do with it. The licensee later mentioned that they had spoken with R2, who acknowledged they had done the action, but was not hurting anyone. The licensee said that it was their right to do the action, but informed R2 that they would need to do it in the bathroom. An interview with R2 regarding the incident was attempted, but R2 became upset, yelled, and stormed out. Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff, resident, and outside source interviews, and records reviewed, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099D of this report. The report was discussed, a plan of correction was jointly developed, and an exit interview was conducted with Licensee Victoria Legaspi. A copy of this report, along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Licensee Legaspi at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, May 19, 2025 · control 08-AS-20250410105904

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: May 30, 2025

87468.1 (a)(1) Personal Rights of Residents in all Facilities: To be accorded dignity in their personal relationships with staff, residents, and other persons... This was not met as evidence by: Based on interviews with residents and staff, staff did not address the indecent exposure incident for 2 of 4 residents in care when they were informed which posed a potential personal rights risk to 2 of 4 residents in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Licensee agreed to move one of the residents to the a different room to ensure the incident does not repeat by POC due date, 05/30/25.

Type of visit: POC

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit for a Plan of Correction (POC) clearance. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of today’s visit. On 4/24/25, the Licensee was issued multiple deficiencies regarding staff training, residents' functional capabilities assessments, residents' pending medical assessments, activities for residents, and facility financial records. At the time of the visit, California Code of Regulations (CCR), Sections 87506 Resident Records, 87456 Evaluation of Suitability for Admission, 87464 Basic Services, 87213 Finances, and Health and Safety Code (HSC), Section 1569.267 Resident’s Bill of Rights, were discussed with the Licensee. A POC was jointly developed with Licensee Legaspi and the deficiencies issued were due between 05/09/2025 through 05/15/2025. During today’s visit, LPA requested copies of their POCs for five (5) of the deficient practice statements that were jointly developed, but they were unable to be produced by the Licensee. A failure to correct was issued for each of the deficiencies on the time elapsed, between the due dates of 5/9/25 through 5/15/25. On 04/17/25, Licensee was issued a deficiency for CCR, Section 87211 Reporting Requirements, due 5/02/25. The licensee was unable to produce the POC, and this deficiency will be reissued and recited during today’s visit. Also, on 04/17/2025, the Licensee was issued a Type A deficiency regarding false/misleading statements. At that time, CCR, Section 87207, was discussed with Licensee Legaspi. A POC was jointly developed with Licensee Legaspi with a due date of 4/18/25. On 4/24/25, Licensee was unable to produce the POC to clear the deficiency, and a failure to correct was issued for the time elapsed, between 4/18/25 through 4/24/25. (Continuation on LIC809-C) (Continuation of LIC809) During today’s visit, the Licensee was still unable to produce the POC, and a failure to correct was issued for the continued deficiency. On 04/02/25, Licensee was issued deficiencies for CCR, Sections 87355 Criminal Record Clearance, 87208 Plan of Operations, HSC Sections 1569.605 Liability Insurance, and Section 1669.15 License application. During today’s visit, Section 87208 is being recited and may be reviewed on the LIC809-D page of this report. On 12/05/2024 and 12/06/2024, the Licensee was issued civil penalties for a visit conducted on 10/28/24, for a total of 6 deficiencies for Personnel Records, Resident Records, Medical Assessments, and Reappraisals. During today's visit, the licensee cleared two citations for resident records, specifically admission agreement, and physician's report, specifically TB test, but will be issued civil penalties until 5/18/25 as it has cleared on 5/19/25. Licensee was issued additional civil penalties as the deficiencies issued on 12/05/2024 and 12/06/2024 have yet to be corrected. Two deficiencies were cleared during today’s visit for citations issued on 10/28/24. An exit interview was conducted, and a copy of this report, along with Licensee Rights (LIC 9058 03/22), and civil penalties issues were provided to Licensee Victoria Legaspi at the conclusion of the visit (via email to the email on file). The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, May 19, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(7)(B) · Plan of correction due date: May 26, 2025

87208 Plan of Operation (a)(7)(B) The licensee shall… operate the facility in accordance with the… plan of operation… Any significant changes… shall be submitted to the licensing agency for approval... This requirement was not met as evidenced by: Based on observation and interview, the Licensee changed the use of facility space and did not submit the updated plan to the Department for approval.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Licensee agreed to submit an updated plan of operation, including but not limited to: a new facility sketch (LIC999), Personnel Report (LIC 500), and updates to ensure compliance with regulations effective January 1, 2025, by the due date, May 26, 2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: May 26, 2025

87211 Reporting Requirements (a)(1)(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident… This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 1 incident were not reported regarding the residents, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Licensee agreed to submit an incident report for the incident that transpired with residents R2 and R3 by the POC due date, May 26, 2025.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced visit for a POC correction and, in conjunction, completed this comprehensive visit initially initiated on April 17, 2025. LPA Lopez identified herself and was granted entry by Victoria Legaspi, Licensee. LPA stated the purpose of the visit and reviewed the basic elements of the visit with Licensee Legaspi. During today’s visit, LPA completed the Comprehensive Visit Inspection Tool. There were deficiencies observed and cited and may be reviewed on the LIC809-D page of this report. An exit interview and a POC was jointly developed with Licensee Legaspi during this visit. A copy of this report, LIC 811 and Licensee/Appeal Rights (LIC 9058 3/22) were provided to the Licensee Legaspi at the conclusion of the visit. The signature below confirms the documents were received.the state’s words, verbatim · CDSS document, Apr 24, 2025

The state marks this report as 27 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: POC

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit for a Plan of Correction (POC) clearance. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of today’s visit. On 04/17/2025, the Licensee was issued a Type A deficiency regarding false/misleading statements. At that time, California Code of Regulations (CCR), Section 87207, was discussed with Licensee Legaspi. A POC was jointly developed with Licensee Legaspi with a due date of 4/18/25. During today’s visit, LPA requested a copy of their POC statement of the uncleared individual which Licensee was unable to provide. A failure to correct was issued for the time elapsed between the due date of 4/18/25 through, 4/24/25. On 12/05/2024 and 12/06/2024, the Licensee was issued civil penalties for a total of 6 deficiencies for Personnel Records, Resident Records, Medical Assessments, and Reappraisals. During today's visit, the licensee was issued additional civil penalties as the deficiencies issued on 12/05/2024 and 12/06/2024 have yet to be corrected. Civil Penalties were issued during today's visit. An exit interview was conducted, and a copy of this report, along with Licensee Rights (LIC 9058 03/22) were provided to Licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 24, 2025

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced Comprehensive Annual Visit as deemed during the NCC on 4/02/2025. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by Licensee Victoria Legaspi, and discussed the purpose of the visit. According to the facility’s license, there may be a maximum of six (6) residents, all of whom may be non-ambulatory in at any given time at the facility site. During today’s inspection, the facility’s current census is 4 residents living at the facility. There were 4 residents present at the facility site during the inspection, but one left during the visit. LPA, accompanied by Licensee Legaspi, toured the interior and exterior of the facility and inspected each room. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable. Hot water temperature at taps accessible to residents were also compliant: sink in restroom #1 delivered hot water at 116.2 degrees Fahrenheit; and sink in restroom #2 delivered hot water at 119.5 degrees Fahrenheit. Staff also had an assigned bathroom #3 and delivered hot water at 122.4 degrees Fahrenheit, and according to the Licensee, residents do not use the staff bathroom. There was a cautionary sign posted. The kitchen sink measured hot water at 120 degrees Fahrenheit. Licensee said the residents do not use the kitchen sink. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking, dining equipment and utensils were present, and all safely stored. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Per licensee Victoria Legaspi, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and the facility telephone were all working. Fire extinguisher(s) were present (02) but not serviced within the last 12 months. First aid kit was complete and accessible. LPA interviewed staff and residents and reviewed staff and resident records. During today’s visit there were 3 residents on the facility premise. The files which LPA reviewed required additional documents. Required licensing postings were observed in a visible area of the facility. LPA did leave the facility premise for approximately one hour duration, during the inspection to have their lunch break. There were deficiencies observed cited during today's comprehensive visit and may be reviewed on the LIC809-D page of this report. Due to unforeseen circumstances, LPA will need to conduct a continuation for this visit. An exit interview was conducted with Licensee Victoria Legaspi to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.the state’s words, verbatim · CDSS document, Apr 17, 2025

The state marks this report as 27 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: POC

Licensing Program Analyst (LPAs) Carmen Lopez conducted an unannounced case management visit for a Plan of Correction (POC) clearance. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of today’s visit. On 04/02/2025, the Licensee was issued a deficiency regarding their expired Liability Insurance. At that time, Health and Safety Code, sections §1569.605 Liability insurance, was spoken with Licensee Legaspi and a hard copy provided to them. A POC was jointly developed with Licensee Legaspi with a due date of 4/16/25. During today’s visit, LPA requested a copy of their Liability Insurance Declaration page which Licensee was able to provide. Although, the POC was deemed cleared during today’s visit, a civil penalty was assessed for failure to correct was issued for the time elapsed between the due date of 4/16/25 and the time the POC was provided, 4/17/25. On 12/05/2024 and 12/06/2024, the Licensee was issued civil penalties for a total of 6 deficiencies for Personnel Records, Resident Records, Medical Assessments and Reappraisals. During today's visit, the licensee was issued additional civil penalties as the deficiencies issued on 12/05/2024 and 12/06/2024, were not yet corrected. An exit interview was conducted and a copy of this report, along with Licensee Rights (LIC 9058 03/22), and copies of the LIC421's, were provided to Licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 17, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit for a Plan of Correction clearance. LPA Lopez identified herself and was allowed entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of today’s visit. On 04/02/2025 the facility was issued a civil penalty (CP) due on 04/03/2025. During today’s visit, LPA confirmed that the CP was cleared on 04/09/2025. The CP was not cleared within the allotted time frame and had lapsed 5 days. New deficiencies were cited during today’s visit and may be found on the LIC809-D page of this report. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee Victoria Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 10, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87761 · Plan of correction due date: Apr 10, 2025

87761 (b) Penalties: (b) Notwithstanding Section 87761(a) above, an immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed if any individual required to be fingerprinted under Health and Safety Code Section 1569.17(b) has not obtained a California clearance or a criminal record exemption, requested a transfer of a criminal record clearance or requested and be approved for a transfer of an exemption as specified in Section 87355 (e) prior to working, residing or volunteering in the facility… this requirement was not met as evidence by: Based on record review, a clearance was not obtained for T2 until after the due date for 1 of 2 individuals prior to residing at the facility.the state’s words, verbatim · CDSS document, Apr 10, 2025

Plan of correction: Cleared during today's visit.

Type of visit: Office

During an office visit with the Licensee, Victoria Legaspi, the San Diego Regional Manager (SDRM), Jerry Romero, Licensing Program Manager (LPM), Robyn Clark, and Licensing Program Analyst (LPA), Carmen Lopez, provided this case management report for recurring issues at the facility. SDRM Romero, LPM Clark, and LPA Lopez identified themselves at the commencement of the visit. SDRM, LPM, and LPA met with Licensee Legaspi and discussed the purpose of today’s visit. During today’s visit at the San Diego Regional Office, SDRM, LPM, and LPA spoke with the Licensee regarding the chronic issues pending at their facility. Deficiencies were cited during today’s visit and may be found on the LIC809-D page of this report. An exit interview was conducted, a plan of correction was jointly developed, and a copy of this report, along with Licensee Rights (LIC 9058 03/22), were provided to Licensee Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355 · Plan of correction due date: Apr 3, 2025

87355 (e)(3) Criminal Record Clearance (e) All individuals subject to a criminal record review… shall prior to working, residing or volunteering in a licensed facility (3) Request a transfer of a criminal record clearance… this requirement was not met as evidence by: Based on record review, interview, and observation, a criminal record clearance transfer was not obtained for 2 of 7 individuals prior to residing at the facility.the state’s words, verbatim · CDSS document, Apr 2, 2025

Plan of correction: Licensee agreed to submit transfer documentation to associate both tenants to their facility roster by POC due date, 4/03/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR87208 · Plan of correction due date: Apr 30, 2025

87208 Plan of Operation (a) (7)(B) The licensee shall… operate the facility in accordance with the… plan of operation… Any significant changes… shall be submitted to the licensing agency for approval... This requirement was not met as evidenced by: Based on observation and interview, the Licensee changed the use of facility space and did not submit the updated plan to the Department for approval.the state’s words, verbatim · CDSS document, Apr 2, 2025

Plan of correction: Licensee agreed to submit an updated plan of operation including but not limited to: a new facility sketch (LIC999), Personnel Report (LIC 500) and updates to ensure compliance with regulations effective January 1, 2025, by due date, April 30, 2025.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Apr 16, 2025

§1569.605 Liability insurance; coverage requirements: On and after July 1, 2015, all residential care facilities for the elderly… shall maintain liability insurance… in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees... This requirement was not met as evidence by: Based on observation and interview, the Licensee did not have an updated liability insurance for the facility which posed a potential health and safety concern for 4 of 4 residents in care.the state’s words, verbatim · CDSS document, Apr 2, 2025

Plan of correction: Licensee agreed to obtain a liability insurance quote and submit it to the Department by due date, April 16, 2025. Declaration page will be obtained once the insurance has been purchased and will be submitted to the Department by POC due date, 4/16/2025.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.15 · Plan of correction due date: Apr 2, 2025

HSC §1569.15 License application; information required; change of information; penalties: (d) The information required… shall be provided to the department upon… licensure, and any change in the information shall be provided to the department within 30 calendar days… of that change. This requirement was not met as evidence by: Based on interview and record review, the Licensee did not notify the Department of change in control of property in 2015, which posed a potential Health, Safety and personal Rights risk to 4 of 4 Residents in care.the state’s words, verbatim · CDSS document, Apr 2, 2025

Plan of correction: This citation was cleared during the time of the visit, on 4/2/2025, as the property's owner had submitted a copy of a lease for the rental property.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit for a health and safety check for residents in care. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of the visit. During today’s visit, LPA toured the facility, spoke with residents and staff, and obtained records pertinent to this visit. LPA informed Licensee Legaspi that possible telephone calls or visits may be necessary to obtain further information. No deficiencies were cited during today’s visit. An exit interview was conducted, and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced case management visit for a Plan of Correction clearance and in conjunction conducted a health and safety check for clients in care. LPA identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of the visit. On 10/28/24, the facility was issued a deficiency regarding updated Administrator’s Certificate. During today’s visit, Licensee informed LPA that deficiency has not been corrected. Civil penalty is being issued for failure to correct and will be ongoing until corrected. No new deficiencies were issued today. Civil penalty issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Dec 5, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced case management visit for a Plan of Correction clearance and in conjunction conducted a health and safety check for clients in care. LPA identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of the visit. On 10/28/24, the facility was issued six deficiencies regarding updated Administrator’s Certificate, and incomplete staff and client files. During today’s visit, Licensee informed LPA that deficiencies have not been corrected.Civil penalties are being issued for failure to correct and will be ongoing until corrected. No new deficiencies were issued today. Civil penalties were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Dec 4, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Victoria Legaspi. According to the facility’s license, the facility is licensed for six (6) non-ambulatory clients. There was a total of four (4) residents in care. LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each client bedroom. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present. Hot water temperature was in compliance. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on premises. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher and first aid kit present. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and reviewed multiple staff/client files. Staff files were not available for LPA review. Client files did not contain all required documents. Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Licensee, to whom a copy of this report, the LIC 809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 28, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit for a Plan of Correction clearance and in conjunction conducted a health and safety check for clients in care. LPA Lopez identified herself and was granted entry by Licensee Victoria Legaspi. LPA met with Licensee Legaspi and discussed the purpose of the visit. On 11/01/23, the facility was issued four deficiencies regarding updated Insurance information, updated CPR training, updated Administrator’s Certificate, and the kitchen being unsanitary and free from rodents and vermin. During today’s visit, LPA inspected the kitchen area and observed that the facility was free from insects and vermin. Licensee had made a contract with a pest control company who renders services to the facility every three months. Licensee provided LPA with their invoices. As such, this deficiency is deemed to be cleared and corrected. Per Licensee Legaspi, the other deficiencies are pending. Based on the information obtained and review of the annual inspection, the facility is being recited during today’s inspection and citations may be reviewed on the attached LIC809-D page of this report. An exit interview was conducted, a plan of correction was jointly developed, and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee Legaspi at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Mar 19, 2024

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Apr 1, 2024

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Based on Licensee interview and record review of the facility file, the licensee did not comply with the section cited above for 5 out of 5 residents in care which posed a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 19, 2024

Plan of correction: Licensee will obtain liability insurance for the facility and submit a copy of their insurance to LPA by POC due date, 4/01/24.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.618(c)(3) · Plan of correction due date: Apr 1, 2024

(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Based on record review of the Licensee's CPR/First Aid certification, the licensee did not comply with the section cited above for 5 out of 5 residents which posed a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 19, 2024

Plan of correction: Licensee will make an appointment to obtain their CPR and first aid training. Licensee will submit a copy of their CPR/First Aid training to LPA by POC due date, 4/01/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(d) · Plan of correction due date: Apr 1, 2024

(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met as evidenced by: Based on Licensee interview and record review of the Administrator's Certificate, the licensee did not comply with the section cited above for 5 out of 5 residents which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 19, 2024

Plan of correction: Licensee will be submitting payment to the Department as a last step to receive their certificate and submit a copy of their payment to LPA by POC due date, 4/01/24. Once Licensee receives their Administrator's Certificate they will submit a copy to LPA.

Allegation investigated: Licensee is retaining a resident who requires a higher level of care. Licensee does not provide a comfortable temperature for resident. Resident has sores possibly due to neglect.

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the finding in the above mention complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Administrator Victoria S. Legaspi. During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents and outside sources. It was alleged that the Licensee was retaining a resident who requires a higher level of care. LPA Domingo observed 3 Residents at the facility. Resident 1 (R1) through Resident 3 (R3) (See LIC811 Confidential Names list), was observed ambulating without any assistance and able to communicate needs. R1 through R3 Physician's report was reviewed and the report accurately reflected R1 through R3 abilities to complete activities of daily living, ability to communicate and ambulate. [Continue on LIC9099C] Unsubstantiated [Continued from LIC9099] It was alleged that the Licensee does not provide a comfortable temperature for residents. LPA Domingo observed the temperature at 70 degrees Fahrenheit. R1 through R3 were interviewed and none of the Resident's had any complaints of the temperature of the facility being uncomfortable. Outside source 1 (OS1) was interviewed and there were no complaints with the temperature of the facility. It was alleged that a Resident has sores possibly due to neglect. Records were reviewed of residents at the facility and no residents had any documentation of sores. Interview with Staff 1 (S1) concurred with records that no residents have any sores. R1 through R3 were interviewed and verbalized they had no sores. Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Licensee , to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jan 3, 2024 · control 08-AS-20200923122416