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

On 04/09/2026, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced case management - legal/non-compliance visit In response to and as per Stipulation/Waiver/Order dated 03/26/26. The purpose of visit is to verify the licensee’s compliance with the terms and conditions outlined in the Stipulation and Order. LPA met with licensee, Prosperidad Gonzales, and explained the purpose of today's visit. During the visit, the LPA obtained and reviewed documentation confirming that a new administrator has been appointed to oversee the day-to-day operations of the facility. The appointed administrator possesses a current and active administrator certificate, which was reviewed and a copy was obtained for the facility file. No deficiencies were cited during this visit.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Required - 1 Year

On 12/31/2025, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Caregiver, Ruth Yep. Licensee, Prospe Gonzales contacted and arrived later in the visit. The facility currently provides care for 5 residents, one of which are receiving hospice services, none of which are bedridden and all are ambulatory. LPA continued with a tour of the facility with staff, Backyard was fenced, secured, and in good condition. All outdoor and indoor passageway were free and clear of obstruction. No accessible bodies of water or fire safety hazards observed. Kitchen was inspected, sufficient supply of food observed. Medications, toxins and sharps stored appropriately and inaccessible to clients, a comfortable temperature was maintained, hot water temperature inspected to be compliant, furnishing and lighting was sufficient for comfort and safety. Carbon monoxide detector and smoke detector system inspected and met the requirements. fire extinguisher checked and fully charged. Licensee has at least one completed first aid kit. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. No deficiencies were cited during the inspection. Two technical violations were identified involving inadequate documentation of the type of emergency addressed in quarterly drills and emergency supplies not meeting the required 72-hour provision in drinking water. The report was reviewed and discussed with licensee, and a copy was left at the facility.the state’s words, verbatim · CDSS document, Dec 31, 2025

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: Case Management - Other

On October 8, 2025, the Licensing Program Analyst (LPA) conducted an unannounced case management visit to follow up on the facility’s information update request and fire clearance status. Upon arrival, the LPA was greeted by caregiver Ruth Yap(S1). Licensee, Prosperidad Gonzales(S2), was not present at the facility at the time of the visit. The LPA contacted Licensee S2 by phone, explained the purpose of the visit, and received permission for caregiver S1 to sign the necessary documents on behalf of the licensee. The facility submitted an application to the Community Care Licensing (CCL) on August 29, 2025, requesting removal of one of the two licensees listed on the license. The facility reported that the licensee being removed had passed away. The LPA requested a copy of the licensee’s death certificate. The facility provided telephone numbers for further contact: 415-242-0848 (facility) and 415-971-0148 (licensee). The LPA also followed up on the fire clearance dated August 28, 2025, where the fire department denied the facility’s request to allow bedridden Resident R1 to remain in care in the future. Licensee S2 reported that Resident R1 recently passed away and that she is in the process of filing the death report. Licensee S2 stated that she will submit both the death certificate for the deceased licensee and the death report for Resident R1 to CCL. The report was reviewed with caregiver S1, and copies were provided.the state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Required - 1 Year

On 12/27/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Caregiver, Ruth Yep. Licensee, Prospe Gonzales was contacted and arrived later in the visit. The facility currently provides care for 4 residents 3 of which were present, none of which are receiving hospice services, none of which are bedridden and some of with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers found throughout the facility were found to be charged. Smoke and carbon monoxide detectors found throughout the facility were also tested and in working order. The facility requested assistance with initiating fire inspection for a potential bedridden clearance in the downstairs bedroom. There are no residents that are currently diagnosed bedridden but facility is requesting for safety measures. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate coverings, enough for residents in care. Cleaning supplies and other toxins are safely stored in locked cabinets under kitchen sinks and garage, all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Residents that were present during the inspection were observed relaxing in their bedroom, watching television or out in the community. The facility encourages regular family visits and utilizes outings for resident activities. There is an outdoor patio with shade and large outdoor space for residents. All residents appear to have a positive relationship during visit and state that they find the level of care to be adequate. Continued onto LIC809-C LPA conducted a sample file review for 4 residents and found 3 out of 3 residents with dementia in need of updated physician's reports. Upon a check for 3 out of 3 staff files, LPA found that caregiver staff have 1st aid and CPR certification on file. However, 3 out of 3 staff require documented annual training records. LPA will provide list of vendorized trainers for Licensee to be in compliance. Technical Violation issued. Lastly, upon a spot check of medications all medication counts and records are in order. LPA requested the following documents be sent to CCL by COB 8/22/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurancethe state’s words, verbatim · CDSS document, Dec 27, 2024

Type of visit: Required - 1 Year

On January 30, 2024 at 9:16 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the unnanounced Annual 1-year required inspection. LPA Calandra was greeted by Manolito Torres, Caregiver at the door and explained the purpose of his visit. Administrator, Prosperidad Gonzales joined the visit later. LPA Calandra toured the physical plant. This is a 2-story building that consists of bedrooms and 2 bathrooms(1 for residents and 1 for staff). Water in all bathrooms was measured between the required 105-120 degrees Fahrenheit. The resident bathroom was observed to have the required grab bar and anti-skid mat. Fire extinguishers in the facility were observed to be fully charged and last checked on March 7, 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 were 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 is being maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's first aid kit was observed to be complete. The facility does not handle any cash resources at this time. LPA Calandra reviewed 4 resident records and 5 staff records. Documents missing include signed Consent Forms, Needs and Services Plans, LIC 602s, etc. 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 requested the following documents from the facility be sent via email or fax to the RO: -Administrator Certificates -Theft and Loss Policy -Liability Insurance -LIC 309-Administrative Organization -Control of Property -Designation of Facility Responsibility During the physical plant tour, LPA Calandra observed a resident who appeared to be bedridden. After an interview with the Licensee/Administrator and R1, LPA Calandra determined that this resident fits the definition of bedridden. LPA Calandra contacted support staff to request a copy of the facility's current fire clearance. The latest fire clearance does not state that bedridden persons can reside in the facility. LPA Calandra discussed with the Administrator that the facility is currently operating outside of their license and that the facility will be cited for this. Additionally, during an interview with the Licensee, LPA Calandra learned that the facility had a client on oxygen. LPA Calandra asked the Licensee if the fire department had been notified and was told they have not. During today's visit the facility was cited for accepting and retaining a bedridden resident without obtaining and maintaining appropriate fire clearance, not including in their plan of operations how the facility plans to care for bedridden residents, failure to have an emergency disaster plan which addresses fire safety precautions specific to evacuation of bedridden residents, staff records not including documentation of staff training related to the care of bedridden residents, and for the use of bed rails without a doctor's written order, and failing to provide on-the-job training to staff who care for residents with Dementia, and failure to complete a medical assessment, and reappraisal for residents on an annual basis. Technical violations were provided for failure to have a written request for acceptance or admittance to or retention in the facility, while receiving hospice services, failing to have an auditory device or other staff alert feature to monitor exits. A Type A violation was provided for failure to obtain fire clearance for bedridden resident. A Technical violation was provided for retaining a bedridden resident and not including additional information in the plan of operations. Deficiencies are cited under California Code of Regulations, Title 22, cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. The report was reviewed with Licensee/Administrator, Prosperidad Gonzales and a copy along with Appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jan 30, 2024

The state marks this report as 18 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Allegation investigated: - Staff caused bruising to resident

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings in regards to the allegations referenced above. LPA met with carfegiver Ruth Yap and explained the purpose of today's visit. During the course of the investigation, LPA conducted interviews, made observations of R1, and reviewed resident documents from the facility. The interview with R1 indicated a possible male in the room watching while S1 was in the room with R1. Interview with S1 says the bruising was not intentional as S1 was trying to assist R1 and remove R1's hands from the clothing of S1 as R1 was grabbing and being combative. R1 says it was someone they have never seen. According to interviews with staff, S1 was a long time staff person so it is not possible it was a person that R1 has never seen as S1 had assisted R1 many times. Additionally the male person that was alleged in the room was said to be the brother of S1 according to R1, but that is also not possible according to interviews. It was suggested that is was possibly another male staff member S2. Interivew with S2 resulted in that he was not working on the day this supposedly took place. There is not enough perponderance of evidence to show that the bruising was caused by S1 and in the manner in which it happened and who was present in the room of R1. The bed of R1 does have half bed rail for mobility reasons and possibly may have hit the half bed rail. This allegation is unsubstantiated. Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. Report is reviewed with Ruth Yap. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 29, 2023 · control 14-AS-20230814121153

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.