Mayflower Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst’s (LPAs) Carmen Lopez and Eryn Kane, conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA’s identified themselves and were granted entry by caregiver’s Emelinda and Joseph Pagulayan. LPAs discussed the purpose of the visit with licensee/administrator Eunice Ambal who later arrived and joined the visit. According to the facility’s license, there may be a maximum of 6 residents, all of whom may be non-ambulatory, and is approved for one bedridden resident in bedroom #2, in at any given time at the facility site. The facility is approved for 3 hospice residents. During today’s inspection, the facility’s current census is 6 residents living at the facility. There were 6 residents present at the facility site during the inspection. LPAs inspected the interior and exterior of the facility and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Resident’s 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 and compliant, at 71º Fahrenheit (F). Hot water temperature at taps accessible to residents were also compliant. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] There were at least 2 days of perishable food, and at least 7 days of non-perishable food present. Cooking, dining equipment and utensils were present, and all stored, but there was a sharp object that was out during the inspection. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked cabinet, which LPA inspected. The facility-maintained medication logs, which LPA reviewed. There were medication inconsistencies which LPA reviewed with the Administrator. No pools or bodies of water on the premises. Per administrator Eunice Ambal, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and the facility telephone were all working. Fire extinguishers were present (01) and serviced within the last 12 months. The first aid kit was complete and readily accessible. LPA spoke with residents and staff, and reviewed staff and resident records. LPAs visit did not raise licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in a locked cabinet. Required licensing postings were observed in a visible area of the facility. There were deficiencies observed and cited during today's annual inspection, which may be found in the LIC809-D pages of this report. An exit interview was conducted with Administrator Eunice Ambal, 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 that the documents were received. LPA requested and received during the inspection a current Designation of Administrative Responsibility (LIC 308), Personnel Report (LIC 500), and Emergency Disaster Plan (LIC610-E).the state’s words, verbatim · CDSS document, Apr 13, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Eunice Ambal. Today's visit was in response to an LIC624 Incident Report, which Licensee self-submitted to the CCLD San Diego Regional Office (received on 5/15/25). According to the LIC624: on 5/15/25, at approximately 7:50am Resident #1 (R1) refused to go with the Outside Agency transportation to attend their day program. R1 advised staff that they were going to the DMV and staff encouraged R1 to wait for the Administrator. R1 left the building and staff followed. [See LIC 811 Confidential Names List for a description of R1.] Local police were called; later that same morning police brought R1 back to the facility unharmed. During today’s visit, LPA performed a brief facility tour and welfare check on R1, verifying that they were unharmed. LPAs also collected copies of pertinent records and interviewed staff. According to R1’s latest LIC602 Physician’s Report (dated 8/6/24), R1 had a primary diagnosis of dementia and was unable to leave the facility unassisted. R1 occasionally wandered and was also confused and disoriented at times. Interviews and records showed: Licensee had a written Absentee Notification Plan, and that staff followed this plan during the incident. Licensee also notified R1’s physician of the incident and performed a timely reappraisal of R1’s care needs. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No deficiencies were cited during today's visit. An exit interview was conducted with Eunice Ambal, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Eunice Ambal. The Licensee previously submitted a written request to the CCLD San Diego Regional Office (RO) seeking to increase the facility's non-ambulatory capacity from four (4) residents to five (5) residents. The request did not involve changing the facility's bedridden capacity, which remains the same at one (1) resident. The request also did not involve changing the facility's total capacity, which remains the same at six (6) residents. On 04/15/25, the local fire authority approved/granted an updated fire clearance, reflecting the facility was approved for six (6) residents in total, of which five (5) may be non-ambulatory and one (1) may be bedridden. Bedroom #2 is approved for one bedridden resident. The updated facility sketch/floor plan was consistent with the current layout of the facility. The Licensee displayed comprehension of the terms of their new facility fire clearance. No deficiencies were observed or cited during today's visit. This portion of the application process has been completed. The Licensee will be sent an updated license to reflect the new fire clearance after CCLD management’s final review and approval. An exit interview was conducted with Eunice Ambal whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Apr 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced required annual inspection. The facility file was reviewed prior to the visit. LPA was allowed entry and discussed the purpose of the visit with Administrator Eunice Ambal. According to the facility’s license, the facility has a maximum capacity of six (6) residents. Facility is approved for three non-ambulatory and one bedridden resident. LPA, accompanied by Administrator toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, 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. Both the ambient and hot water temperature were at compliant readings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. There were no bodies of water on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C] LPA reviewed multiple staff and resident records/files. LPA records review did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Eunice Ambal whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was allowed entry and discussed the purpose of the visit with Administrator Eunice Ambal. According to the facility’s license, the facility has a maximum capacity of six (6)residents. Facility is approved for three non-ambulatory and one bedridden resident. During today’s inspection there were 5 residents present in the facility. LPA, accompanied by Administrator toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, 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, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. There were no bodies of water on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C] LPA interviewed staff and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Eunice Ambal whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Mar 22, 2024