Advent Residential Home II

Type of visit: Required - 1 Year

On 08/26/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with administrator Editha Muncada and explained the purpose of today's visit. There are 6 residents and 2 staff present, one being the administrator. This is a single level facility. All residents are approved to be non-amblatory and 3 hospice residents per waiver on file. There are 3 residents on hospice at this time. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the facility stove. Medications are observed to be locked in a kitchen cabinet. Perishable and non-perishable food items are observed as in place. Cleaning supplies are observed to be locked beneath kitchen sink and outside. First aid kit is observed as complete with required items. LPA observed that there are three fire extinguishers in place last inspected 07/09/2026, smoke detectors, carbon monoxide detectors are observed in place through out the facility, facility is equipped with full fire sprinklers through out, and central heating system including fans for facility use. PPE supplies and linen supplies are in place. Laundry area is also observed as fully operational in an exterior shed. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Facility does not have a record for conducting an emergency which can pose a potential health and safety. Continued on next page... Page 2 Water temperature was measured at 115F in a common bathroom in the hallway connecting to resident rooms. There is one bathroom that is out of order in the living room area that is used for storage but there are an additional two full bathrooms for resident use. LPA observed resident rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Client linen supplies are observed as in place. Facility disaster drill conducted on 06/22/2026. LPA reviewed 4 of 6 resident files due to computer issues and 3 staff files are reviewed. 1 of the 3 staff files reviewed shows that there is no first aid card on file. Administrator certificate is observed with a expiration date of 08/13/2026, but according to the administrator, she has sent renewal items already and is waiting for the new certificate. LPA observed certified mail receipt showing that she sent the renewal already. The following updated forms are requested to be submitted to CCLD by 09/02/2026: • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule Citation issued on following LIC809D and technical violation is issued and attached on the following LIC9102TV page. Report is reviewed with administrator Editha Muncada.the state’s words, verbatim · CDSS document, Aug 26, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c)(1) · Plan of correction due date: Sep 2, 2026

87411(c)(1) Personnel Requirements - (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. Based on staff records reviewed, 1 of 3 staff files had current first aid cards. According to documentation reviewed, S2 does not have a current first aid card on file. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 26, 2026

Plan of correction: The facility shall submit a plan of correction showing that the facility will meet this requirement at all times. Proof of first aid card for S2 is to be received as well.

Type of visit: Required - 1 Year

On 07/15/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with administrator Editha Muncada and explained the purpose of today's visit. There are 7 residents and 2 staff present, one being the administrator. This is a single level facility. All residents are approved to be non-amblatory and 3 hospice residents per waiver on file. There are 3 residents on hospice at this time. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the facility stove. Medications are observed to be locked in a kitchen cabinet. Perishable and non-perishable food items are observed as in place. Cleaning supplies are observed to be locked beneath kitchen sink. First aid kit is observed as complete with required items. LPA observed that there are three fire extinguishers in place last inspected 08/15/2024, smoke detectors, carbon monoxide detectors are observed in place through out the facility, facility is equipped with full fire sprinklers through out, and central heating system including fans for facility use. PPE supplies and linen supplies are in place. Laundry area is also observed as fully operational in an exterior shed. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Facility does not have a record for conducting an emergency which can pose a potential health and safety. Water temperature was measured at 120F in a common bathroom in the hallway connecting to resident rooms. There is one bathroom that is out of order in the living room area that is used for storage but there are an additional two full bathrooms for resident use. Continued on next page... Page 2 LPA observed resident rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Client linen supplies are observed as in place. Facility disaster drill conducted on 04/03/2025. LPA reviewed 6 of 7 resident files due to computer issues. 3 staff files are reviewed as current Administrator certificate is observed as current expiring on 08/13/2026 The following updated forms are requested to be submitted to CCLD by 07/22/2025: • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule Technical violation are issued and attached on the following LIC9102 page. Report is reviewed with administrator Editha Muncada.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: Required - 1 Year

On 07/23/2024, Licensing Program Analyst (LPA) Jaime Vado and conducted an unannounced annual inspection visit. LPA met with administrator Editha Muncada and explained the purpose of today's visit. LPA was allowed entry into the facility. This is a single level facility. All residents are approved to be non-amblatory and 2 hospice residents. There are 2 residents on hospice at this time. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the facility stove. Medications are observed to be locked in a kitchen cabinet. Perishable and non-perishable food items are observed as in place. Refrigerator is observed as having both lights out inside the freezer and main refrigerator. Additionally the lower refrigerator drawers and bins are broken or not in place leaving some fresh food supplies exposed and leftover food is not labeled with dates. This can pose a potential health and safety risk. Cleaning supplies are observed to be locked beneath kitchen sink. First aid kit is observed as complete with required items. LPA observed that there are multiple fire extinguishers in place last inspected 08/06/2021, smoke detectors, carbon monoxide detectors are observed in place through out the facility, facility is equipped with full fire sprinklers through out, and central heating system including and fans for facility use. PPE supplies and linen supplies are in place. Laundry area is also observed as fully operational in an exterior shed. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Facility does not have a record for conducting an emergency which can pose a potential health and safety. Water temperature was measured at 115F in a common bathroom in the hallway connecting to resident rooms. Continued on next page... Page 2 LPA observed resident rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Client linen supplies are observed as in place. The following updated forms are requested to be submitted to CCLD by 07/31/2024: • Copy of updated Administrator Certificates • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property or current lease Technical violations are issued and attached on the following LIC9102 pages. Report is reviewed with administrator Editha Muncada.the state’s words, verbatim · CDSS document, Jul 24, 2024

Allegation investigated: - Staff spoke inappropriately to resident - Staff handle resident in a rough manner - Staff do not use the appropriate equipment to transfer resident resulting in injury to resident - Staff did not inform resident's authorized representative of resident’s injuries

LPA Jeung interviewed resident. Based on client records reviewed and interviews with client and staff, these allegations are determined to be unsubstantiated. Not enough information was provided to conduct a more thorough investigation. Client #3 moved out in November 2022 after facility issued 30-day notice. Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 2, 2024 · control 14-AS-20221012091342

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.

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds, consisting of 6 client bedrooms and 4 full bathrooms--3 are for client use. Administrator resides in detached garage, that has been renovated as living space with 2 sleeping rooms. Clothes washer and dryer are located in semi-enclosed structure attached to outside of kitchen/dining area. There is a detached storage shed in back yard where diapers are stored. No accessible bodies of water or fire safety hazards observed. PPE supply is inspected. Food supplies are adequate. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 6 residents present and 2 staff. Two residents are receiving hospice services. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, including current first aid training and health screenings. Edith Muncada is a certified RCFE administrator (x 8/24) that oversees facility operations. The following information/forms are requested to be submitted to CCLD BY 11/4/22: - Personnel Report (LIC500) - Emergency Disaster Plan (LIC610E) Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Technical Violations are issued--see 11 pages.the state’s words, verbatim · CDSS document, Jan 2, 2024

The state marks this report as 18 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.