Cleo's Home 3

Allegation investigated: Staff do not prevent a rodent infestation

On 09/03/2026 Licensing Program Analyst (LPA) Melina Oropeza arrived at facility unannounced to continue a complaint investigation in to the above listed allegation. LPA Oropeza met with staff, Edwin Dimaculangan and explained explained the purpose of today's visit. The administrator, Cleo Brelin was contacted and LPA explained the purpose of today's visit. The administrator was unavailable due to having a previous scheduled appointment. LPA toured the interior and exterior of the facility, conducted interviews and reviewed pest control records. During the facility inspection, LPA did not observe rodents, rodent droppings, nesting materials, foul odors, or other evidence of an active rodent infestation. Pest control records were reviewed and indicated that the facility receives pest control services and has measures in place to address rodent activity. Based on observations, interviews conducted and records reviewed, there is insufficient evidence to determine that staff failed to prevent or address a rodent infestation, the allegations are unsubstantiated. Unsubstantiated Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore, the allegations are UNSUBSTANTIATED. Exit interview was conducted and a copy of the report was given to staff member, Edwin Dimaculangan . No citations were issued per Title 22 regulations.the state’s words, verbatim · CDSS document, Sep 3, 2026 · control 27-AS-20260708085133

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 12/12/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Cleo Brelin, who was briefly interviewed at this time. Current census was 4 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there was (1) resident diagnosed with dementia at this time. It was learned that there was (1) resident receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 7032688740, for Cleo Brelin was observed to have an expiration date of 07/17/2026 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility living room cabinet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the laundry room, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher that was located in the kitchen area was observed to have been annually purchased from the local hardware store on 12/30/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted and noted on the following LIC 859. A review of (4) facility resident records was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 12, 2025

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 12/30/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Cleo Brelin, who was briefly interviewed at this time. Current census was 3 residents. It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6041889740, for Cleo Brelin was observed to have an expiration date of 07/17/2026 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility living room cabinet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the laundry room, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher that was located in the kitchen area was observed to have been annually purchased from the local hardware store on 12/30/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (4) facility personnel records was conducted on the LIC 859. A review of (3) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 30, 2024

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 12/30/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Cleo Brelin. A brief interview was conducted with the facility designated Administrator at this time. Current census was 3 residents.. The purpose of this visit was to follow up on the deficiencies that were cited from a prior post licensing visit conducted on 05/02/2024. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 05/02/2024: The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Plan of Correction clearance letter was printed and a copy was provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 30, 2024

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 05/02/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Cleo Brelin, at this time. A brief interview was conducted with the facility designated Administrator at this time. It was learned that this facility was licensed to accept and retain up to 6 non ambulatory residents at any given time. This facility also has a fire clearance for (1) bedridden resident and an approved hospice waiver for (6) residents. Current census was 3 residents. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator at this time. A review of the facility Medication Administration Record and dispensing log was conducted. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Laundry area was toured. Cleaning supplies, detergents, and bleach were observed to be present and made inaccessible to the residents at this time. Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the garage area was conducted. First aid kits were observed to be present and contained all of the required components at this time. Fire extinguisher was observed to be placed in the kitchen area and was just recently purchased and found to be in compliance at this time. A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (3) facility resident files was conducted and noted on the following LIC 858. A review of (3) facility staff files was conducted and noted on the following LIC 859. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, May 2, 2024

Type of visit: Case Management - Other

Unannounced case management visit made out to this facility on 01/05/2024 by Licensing Program Analyst (LPA) Charlie Yang at the address of 2372 Blue Tees Drive in Stockton, CA 95206. This LPA attempted to make contact with the facility staff, or any representatives, at this time. After several attempts of ringing the doorbell and waiting for a response, this LPA retreated to his vehicle to attempt contact with the facility designated Administrator, Cleo Brelin, via telephone. This LPA was able to reach the facility designated Administrator on the phone. A brief interview was conducted with the facility designated Administrator at this time. It was learned that this facility on Blue Tees no longer had any residents in care. The facility designated Administrator stated that all residents (2) had been relocated to Cleo's Home 2 located at 2426 West Alpine in Stockton, CA 95204 since 12/28/2023. Current census was 0 residents.the state’s words, verbatim · CDSS document, Jan 5, 2024

Type of visit: Prelicensing

Announced Prelicensing visit made out to this facility on 12/07/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Cleo Brelin, at this time. A brief interview was conducted with the facility designated Administrator at this time. It was learned that this facility was seeking licensure to accept and retain up to 6 non ambulatory residents at any given time. This facility is seeking licensure for (1) bedridden resident and an approved hospice waiver for (6) residents. Current census was 0 residents. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator at this time. A review of the facility Medication Administration Record and dispensing log was conducted. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Laundry area was toured. Cleaning supplies, detergents, and bleach were observed to be present and made inaccessible to the residents at this time. Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the garage area was conducted. First aid kits were observed to be present and contained all of the required components at this time. Fire extinguisher was observed to be placed in the kitchen area and was just recently purchased and found to be in compliance at this time. A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted. This facility was found to be in compliance at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 7, 2023