RJ Starlight Home

Type of visit: Required - 1 Year

On February 25, 2026, Licensing Program Analyst(LPA) Yi Sam Jian arrived at the facility at to conduct an unannounced Annual 1-year required inspection. LPA met with Lorna Gonzales, Caregiver. The Administrator, Teresita Jomok joined later during the visit. Administrator gave permission to caregiver to sign the report. LPA toured the physical plant. This is a story building that consists of 6 rooms and 3 bathrooms. Bathrooms were observed to have the required grab bars. Fire extinguishers in the facility were observed to be fully charged. No food was expired. All bedrooms were sufficiently lit and had the required furniture. The backyard was clear from obstructions. No accessible bodies of water or hazards were observed. The facility's first aid was observed to be complete. The facility does not handle any cash resources. The facility was maintained at a comfortable temperature. All knives and sharp objects were observed to be locked and in-accessible to persons in care. All medications, soaps, and detergents were observed to be locked and in-accessible to persons in care. No deficiencies were cited during today's visit. Facility staff turned down the temperature of the water down in the presence of the LPA. Technical Advisory Note provided for incomplete records of quarterly emergency drills. The report was reviewed with administrator and a copy was left at the facility.the state’s words, verbatim · CDSS document, Feb 25, 2026

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On February 27, 2025, Licensing Program Analyst(LPA) Yi Sam Jian arrived at the facility at to conduct an unannounced Annual 1-year required inspection. LPA met with Lorna Gonzales, Caregiver. The Administrator, Teresita Jomok joined later during the visit. LPA toured the physical plant. This is a story building that consists of 6 rooms and 3 bathrooms. Facility staff turned down the temperature of the water down in the presence of the LPA and inspected to be in compliant. Bathrooms were observed to have the required grab bars. Fire extinguishers in the facility were observed to be fully charged. No food was expired. The kitchen refrigerators and freezers temperature was within the required range. All bedrooms were sufficiently lit and had the required furniture. The backyard was clear from obstructions. No accessible bodies of water or hazards were observed. The facility's first aid was observed to be complete. The facility does not handle any cash resources. The facility was maintained at a comfortable temperature of 71 degrees Fahrenheit. All knives and sharp objects were observed to be locked and in-accessible to persons in care. All medications, soaps, and detergents were observed to be locked and in-accessible to persons in care. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies were cited during today's visit. Technical Advisory Notes provided. The report was reviewed with administrator and a copy was left at the facility.the state’s words, verbatim · CDSS document, Feb 27, 2025

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.

Allegation investigated: Illegal eviction

On 1/22/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Amelia Arcinas, Lead Staff. LPA toured the facility, interviewed residents, staff and outside parties, reviewed resident records, and made observations during the course of the investigation. Complaint alleges an illegal eviction towards resident (R1). Upon interviews with staff (S1 & S2), residents (R2 & R3) it was indicated that R1 had left the facility voluntarily and further stated that R1 was highly verbally aggressive towards staff and other residents. S1 further explained that the facility did not evict R1 but was R1’s decision to leave the facility with no further contact. The facility followed with appropriate reporting requirements from the incident. Reviewing R1’s medical assessment indicated that R1 can leave the facility unassisted. Additional interview with San Francisco Department of Public Health Social Worker, (I2) confirmed that R1 had left the facility voluntarily with no notice or contact to either the facility or I2. I2 is responsible for R1’s placement and indicated that R1 had left San Francisco area for approximately 1 month and returned around 10/25/2024. I2 stated that during the time frame that R1 was unable to be located; R1’s placement at the facility was ended by I2 after a two week hold on R1’s placement in case R1 returned. Upon R1’s return and contact with I2; R1 was admitted into a temporary shelter located in San Francisco. I2 stated that they were in the process of completing a medical assessment for R1, required for DPH clearance when transferring into another long term care facility. I2 further stated that R1 was not cooperative with completing the medical assessment, delaying R1 in being properly placed in a new facility. Continued onto LIC909-C Unfounded The agency has investigated the allegation and we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted. This report was reviewed with the Director and a copy of the report left at the facility. No deficiency cited.the state’s words, verbatim · CDSS document, Jan 22, 2025 · control 14-AS-20241025153119

Allegation investigated: Facility has pests.

On April 24, 2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver complaint investigation findings. LPA met with caregiver and explained the purpose of today's visit. Regarding to allegation of- facility has pests, the reporting party stated that he/she witnessed resident scratching themselves and reporting party also reported that facility has bedbugs. As part of the investigation, LPA interview resident in question(R1), staff and administrator. The administrator acknowledged that the facility has bedbugs and it has been a chronic problem. In addition, the administrator stated that they have been getting monthly pest control services from Terminix to treat the bedbugs. LPA interviewed staff #1 (S1) who acknowledged that there is bedbugs in some of the resident's room and they clean the rooms everyday but the bedbugs remain. In addition, S1 stated that Terminix comes to the facility frequently to treat the bedbugs. Substantiated LPA interviewed R1 who stated that there is bedbugs on his/her mattress and he/she gets bit all the time at night. Based on documents provided by the facility, LPA observed Terminix services were provided on a regular basis. After the investigation, this allegation is deemed to be substantiated. Although the facility has regular Terminix services to treat the bedbugs and daily cleaning by staff, residents are still being affected. Based on interviews and record reviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation is determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with caregiver and Administrator who was on the phone. A copy of this report and the Appeal Rights provided. According to staff #1(S1) who was at the facility during the incident. When R1 reported being hit by R2, S1 called the administrator immediately and reported the incident. S1 stated that they are monitoring both residents more frequently but it could be a challenge as both residents are ambulatory, and they come and go as they please. After the investigation, this allegation is deemed to be unsubstantiated as R1 was hit by R2 on January 11, 2024. However, there is no indication of staff neglect as residents are ambulatory, physician's orders stated that they could leave the facility unassisted and they come and go multiple times on a daily basis. Regarding to the allegation of - staff are not ensuring that a resident is able to sleep at night, the reporting party stated that R1 is unable to sleep as R2 returns to the facility sometimes late at night after roaming around the city. As part of the investigation, LPA interviewed the administrator and R1. According to the administrator, both residents are ambulatory and they can leave the facility unassisted. R2 leaves the facility everyday and R2 goes in and out of the facility frequently to smoke so R2 may be disturbing R1's sleep. The administrator has offered both of them room transfers but they declined. The administrator discussed room transfer with R1's responsible party who also declined. The administrator offered R1 to move to another facility and it was also declined and currently, the administrator is working with Public Health SW on seeking a different facility for R2. After the investigation, this allegation is deemed to be unsubstantiated as the facility offered different interventions to ensure R1 gets sleep at night, however, all of them were declined by R1 and R1's responsible party. The administrator is working with Public Health SW to seek for another facility for R2. Although the above investigations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. This report is reviewed and discussed with caregiver and administrator on the phone. A copy is provided. Regarding to the allegation of - facility is illegally evicting a resident from the facility, the reporting party stated that the facility is trying to evict R2 as R2 assaulted R1 on January 11, 2024. As part of the investigation, LPA interviewed the administrator who stated that the facility was advised by SF Department of Public Health Social Worker to issue an 3-day eviction notification to R2 and the administrator generated the letter and faxed it to CCL for approval. However, the letter was never given to R2 as the administrator did not get an approval from CCL. In addition, the administrator stated that they are working with SF Public Health to discharge R2. During the 10-day visit, LPA attempted to interviewed R2 but R2 did not want to be interviewed. Based on documents provided by the administrator, the facility faxed the eviction notification CCL for approval and the notification was not presented to R2 because an approval was not obtained from CCL. After the investigation, this allegation is deemed to be unfounded because the facility requested an approval from CCL prior to delivering a 3-day eviction notification for R2 and it was not given to R2 as it was not approved by CCL. Based on interviews, the department has determined that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED. This report is reviewed and discussed with caregiver and administrator over the phone. . A copy is provided.the state’s words, verbatim · CDSS document, Apr 24, 2024 · control 14-AS-20240214183731

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Apr 25, 2024

87303 Maintenance and Operation..(a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on observation, record review and interview, facility has bedbugs which poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Apr 24, 2024

Plan of correction: The administrator/licensee shall develop a plan to ensure the facility is cleaned, safe and sanitary to all residents. The plan shall have a different intervention as the current plan is not working. The administrator will submit a copy of the plan to CCL by 4/25/2024.

Type of visit: Required - 1 Year

On February 13, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:14 AM to conduct an unannounced Annual 1-year required inspection. LPA Calandra met with Amelia Arcinas, Caregiver. The Administrator, Teresita Jomok was unable to join the visit. LPA Calandra toured the physical plant. This is a story building that consists of 6 rooms and 3 bathrooms. Water in all bathrooms was measured above the 125 degrees Fahrenheit. Facility staff turned down the temperature of the water down in the presence of the LPA. Bathrooms were observed to have the required grab bars and anti-skid mats. Fire extinguishers in the facility were observed to be fully charged and last checked on April 12, 2023. The facility had the required 7 days of non-perishables and 2 days of perishables on site. No food was expired. The kitchen refrigerators and freezers temperature was within the required range. All bedrooms were sufficiently lit and had the required furniture. The backyard was clear from obstructions. No accessible bodies of water or hazards were observed. The facility's first aid was observed to be complete. The facility does not handle any cash resources. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. All knives and sharp objects were observed to be locked and in-accessible to persons in care. All medications, soaps, and detergents were observed to be locked and in-accessible to persons in care. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA Calandra reviewed 5 resident and 3 staff files. All were observed to be complete. No deficiencies were cited during today's visit. The report was reviewed with Caregiver, Amelia Arcinas and a copy was left at the facility.the state’s words, verbatim · CDSS document, Feb 13, 2024