Peninsula Elderly Care Home-Laurel

Type of visit: Required - 1 Year

***amended report*** On 7/24/2026, Licensing Program Analyst(LPA) Grace Donato arrived at the facility to conduct the Annual 1-year required inspection. LPA met with Care Staff Evelyn Tabago, Jennifer Tobias, Administrator arrived later during the visit. LPA toured the physical plant. Facility is a 1-story building with 7 bedrooms, 3 bathrooms, a living room, dining room, kitchen, laundry room, garage, front and back yards. All bedrooms had the required furniture and sufficient lighting. Bathrooms had the required anti-skid floor mats and shower bars. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. The facility's hot water temperature was measured 108 degG. The facility had the required 7 days of non perishables and 2 days of perishables on site. The facility temperature was maintained at 71 deg. The facility's fire extinguishers were observed to be fully charged. Sharp objects, soap, detergents, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed five resident records and tow staff records. Everything is complete and updated. Medication is in a locked cabinet. Medication was reviewed and found to be complete. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Jul 24, 2026

Type of visit: Case Management - Annual Continuation

On 6/18/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Jennifer Tobias, Administrator and explained the purpose of the visit. LPA reviewed 5 resident files and 6 staff files. All were observed to be complete. LPA interviewed 6 residents and 3 staff. 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. Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties. An exit interview was conducted. A copy of the report along with Appeal Rights was left at the facility.the state’s words, verbatim · CDSS document, Jun 18, 2025

Type of visit: Required - 1 Year

On 5/22/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Rolly Tabago, Caregiver and Evelyn Tabago, Caregiver and explained the purpose of the visit. Jennifer Tobias, Administrator arrived later during the visit. LPA toured the physical plant. This is a 1-story building with 7 bedrooms, 3 bathrooms, a living room, dining room, kitchen, laundry room, garage, front and back yards. All bedrooms had the required furniture and sufficient lighting. Bathrooms had the required anti-skid floor mats and shower bars. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. The facility's first aid kit was observed to have all required items. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's fire extinguishers were observed to be fully charged and last checked on 4/8/2025. Sharp objects, soap, detergents, and poisons were observed to be locked and in-accessible to persons in care. The Annual Inspection will be completed at a later date. Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator, and a copy of the report along with Appeal Rights left at the facility.the state’s words, verbatim · CDSS document, May 22, 2025

Type of visit: Case Management - Incident

On November 6, 2024, Licensing Program Analyst (LPA) John Calandra arrived at the facility at 8:30 AM to conducted an unannounced follow up Case Management visit. Purpose of visit is due to a self reported incident that was reported on 10/26/2024. LPA Calandra was greeted by Evelyn Tabago, Caretaker and explained the purpose of the visit. Jennifer Tobias, Administrator arrived later during the visit. On October 26, 2024, the Department received a report from the facility stating that R1 had slapped and spit on S1. Per interview with the Administrator, Jennifer Tobias, R1 went to see R1's Neurologist recently and new medications have been prescribed but not started yet. During the visit, LPA reviewed R1's LIC 602 and Care Plan and obtained electronic copies of both documents. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Nov 8, 2024

Type of visit: Case Management - Incident

On November 6, 2024, Licensing Program Analyst (LPA) John Calandra arrived at the facility at 8:40 AM to conducted an unannounced Case Management visit. Purpose of visit is due to a self reported incident that was reported on 10/26/2024. LPA met with Administrator, Jennifer Tobias and explained the purpose of the visit. Neeru Verma, Head of Operations arrived later during the visit. The incident occurring on 10/26/2024, involved a resident (R1) striking and spitting on a staff member, S1. The incident was reported to CCLD and confirmed based on the incident report and interview with Administrator, Jennifer Tobias. During the visit, LPA Calandra interviewed 4 residents, staff, and Administrator. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Nov 6, 2024

Type of visit: Case Management - Annual Continuation

On July 18, 2024, Licensing Program Analysts(LPAs) John Calandra and Yi "Sam" Jian, arrived at the facility at 8:39 AM to complete the annual 1-year required unnanounced Annual Inspection. LPAs Calandra and Jian were greeted by Alma Tamonte, Caregiver and explained the purpose of their visit. Administrator, Jennifer Tobias arrived later during the visit. LPAs Calandra and Jian reviewed 4 staff files. All were observed to be complete. LPAs Calandra and Jian interviewed 2 residents and 3 staff. A Technical Violation was provided for not having a internet accessing device present that allows a resident to access it for discussion of personal or confidential information with a reasonable level of personal privacy. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jul 18, 2024

Type of visit: Required - 1 Year

On June 19, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 1:56 PM, to complete the Annual 1-year required inspection. LPA Calandra was greeted by Evelyn Tabajo, Caregiver and explained the purpose of the visit. Administrator, Jennifer Tobias arrived later during the visit. LPA Calandra toured the physical plant. This is a 1-story building with 7 bedrooms, 5 bathrooms, a front yard and backyard, living room, dining room, kitchen, 2 storage spaces, and staff quarters in the garage. The facility's Fire Extinguisher was observed to be fully charged and last inspected on April 4, 2024. The facility's Fire Alarms and Carbon Monoxide detectors were observed to be in working order. All bedrooms had the required furniture and sufficient lighting. There were no accessible bodies of water or hazards observed. The facility's First Aid had the required items. Hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility was maintained at a comfortable temperature of 75 degrees Fahrenheit. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. LPA Calandra reviewed 5 resident files. All were observed to be complete. All Sharp objects, disinfectants, and cleaning supplies were observed to be locked and in-accessible to persons in care. LPA Calandra also reviewed Centrally Stored Medication Records. 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(CSMR) kept at the facility. No deficiencies were cited during today's visit. The Annual will be completed on a later date. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jun 19, 2024

Allegation investigated: -Staff interfered with authorized representative’s medical decision

On February 22, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver findings for the above allegation. LPA met with Administrator, Jennifer Tobias and explained the purpose of the visit. Regarding the allegation, staff interfered with authorized representative’s medical decision, according to the reporting party, Resident 1’s (R1’s) authorized representative wanted to continue R1’s care with HealthFlex Hospice as they are familiar with R1’s needs, however the administrator told R1’s authorized representative that the facility will be requesting a transfer to a different hospice agency. In addition, the reporting party indicated that R1’s authorized representative was distraught about being coerced in using the facility’s preferred hospice agency. During the investigation, LPA conducted interviews, and reviewed R1’s file. Administrator and Licensee denied this allegation and indicated that they have never forced any resident or family member to choose a hospice agency. According to the Administrator, R1 is currently not on hospice. Administrator indicated that R1 was with HealthFlex Home Health and was in the process of being admitted to HealthFlex hospice, however R1’s authorized representative indicated that he/she requested for another hospice agency to care for R1 but was taken to the hospital. R1 currently is still with HealthFlex Home Health and does not require hospice care. According to R1’s authorized representative interviewed, R1’s physician ordered R1 to be under the care of HealthFlex hospice, however R1’s authorized representative wanted to explore more options and preferred a different hospice agency over the one recommended by the doctor. In addition, R1’s authorized representative denied being forced into choosing a different hospice agency as HealthFlex was not chosen by him/her. Based on the above information, the Department has found that this allegation to be UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis. Report is reviewed with administrator, and a copy is provided. Unfoundedthe state’s words, verbatim · CDSS document, Feb 22, 2024 · control 14-AS-20240206093051

Type of visit: Required - 1 Year

On February 13, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Administrator, Jennifer Tobias and Licensee, Neeru Verma and explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageways were free of obstruction. No accessible bodies of water of fire safety hazards observed. Extra linen was observed. LPA toured seven private resident bedrooms and five bathrooms; two full and three half baths. All resident rooms were observed with all required furniture. Bathrooms were observed clean and odor-free; equipped with liquid soap and paper towels. Living room and dining room was observed to be free from tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort. Hot water throughout the facility measured between 114.6-118.9 degrees F throughout the facility. Sharps, toxins and medication were locked and inaccessible to residents. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of April 2023. LPA observed 2 days for perishables and 7 days non-perishables. Emergency drills are logged and done every three months. During the visit, ants were observed on the floor near the dining room table. According to the Licensee, they have pest control come every month to treat the ants and pests. Invoice provided to LPA shows pest control came on 2/5/2024 and treated the home. Licensee called pest control during the visit; pest control will be back to the facility tomorrow to inspect the facility again. LPA reviewed 5 resident records and 4 staff records. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No citations are issued during the visit. LPA reviewed report with Licensee and Administrator and a copy is provided.the state’s words, verbatim · CDSS document, Feb 13, 2024