Saint Jarielle Residential Care 2

Type of visit: Required - 1 Year

On 5/21/2026, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator Nancy Uy. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, garage, and kitchen area and backyard. LPA observed a small storage shed at the back of the facility. While touring the facility it was observed that the room temperature was at 69 deg F. Hot water was also tested in the bathrooms and the temperature was 110 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed locked. Food supply in kitchen and garage refrigerator was observed with an adequate two day perishable and seven day non-perishable food supply. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill is done every quarter. Three resident records and three staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. Administrator will send the Liability Insurance to LPA. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, May 21, 2026

Allegation investigated: Staff did not have planned activities

On January 15, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings of a complaint investigation. LPA met with caregiver, Alice Monton and explained the purpose of today's visit. The caregiver called and informed the administrator of LPA's visit. Regarding the allegation of staff did not have planned activities, the reporting party stated the facility does not have any planned activities for residents. As part of the investigation, LPA interviewed resident #1 (R1), resident #2 (R2), Staff #1 (S1), and administrator. According to R1 and R2, the facility did not provide any planned activities, and both of them stated that they enjoyed watching sports but the TV in the living room has been broken for many months. Substantiated LPA interviewed the administrator and S1 and neither could provide details pertaining to the activities that the facility has for the residents. During the 10-day complaint visit, LPA did not observe any activities at the facility and LPA observed the TV was broken (The facility was cited on 10/29/2025 and the TV has been replaced). The State Official also reported that during his/her visits, there were no activities at the facility. After the investigation, this allegation is deemed to be substantiated. Based on interviews and record reviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegations were 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 the administrator who was on the phone. A copy of the report and the appeal rights were provided. LPA interviewed resident # 2 (R2) who stated that staff are assisting and providing the care that R2 is required. LPA interviewed staff #1 (S1) who stated that they offered R1 to get out of bed but R1 did not want to due to R1's physical condition. After the investigation, this allegation is deemed to be unsubstantiated. Regarding the allegation of- due to lack of supervision, resident went into another resident's room during the night, the reporting party stated that resident #3 (R3) enter R1's room at night, covering R1 with a blanket which resulted R1 being scared and panicking. As part of the investigation, LPA interviewed R1, R2, and S1. According to S1, when the incident happened, R1 and R3 were roommates so R3 did not enter another resident's room and R3 thought R1 was cold so R3 walked over to R1’s bed and covered R1 with a blanket. S1 stated that after the incident, they moved R3 to another room and there were no further incidents. According to R1, S1 was present when it happened and S1 redirected R3 to another room. R1 stated that he/she was scared but it did not happen again after R3 was transferred to another room. According to R2, R3 never entered his/her room and there were always staff members at the facility. After the investigation, this allegation is deemed to be unsubstantiated. 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. Report was discussed with caregiver and the administrator who was on the phone. A copy of the report was provided. LPA interviewed S1 who stated that they offered R1 to take a shower but R1 preferred to have sponge baths in bed, and they provided that several times a week. During the 10-day complaint visit on 10/19/2025, R1 appeared to be cleaned and well-groomed. After the investigation, this allegation is deemed to be unfounded. Regarding the allegation of Reporting Requirement- the reporting party stated that resident #3(R3) went into R1's room and covered R1 with a blanket up to R1's and this incident was not reported to CCL. As part of the investigation, LPA interviewed the administrator and S1. The administrator stated that R1 and R3 were sharing a room and R3 thought R1 was cold so R3 went to R1's bed and covered R1 up to the neck. The administrator stated that they did not report it to CCL because it was not a reportable incident and there was no injuries to both residents. The administrator stated they moved R3 to another room after the incident and there were no further incidents. LPA interviewed S1 who stated that she was present when this happened and R3 was concerned that the roommate (R1) was cold so R3 covered R1 with a blanket and R1 got scared. S1 stated that R3 was moved to another room right away and both residents were fine afterwards. After the investigation, this allegation is deemed to be unfounded. Based on interviews, and record reviews, the department has determined that the allegation was false, could not have happened and/or is without a reasonable basis, therefore the allegation is UNFOUNDED. Report was discussed with caregiver and the administrator who was on the phone. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 15, 2026 · control 14-AS-20251020093609

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a) · Plan of correction due date: Jan 22, 2026

87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities.... This requirement is not met as evidenced by based on observation, record review, and interviews, the facility does not have planned activities which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: The administrator/licensee will develop a plan of correction to ensure the facility has variety of activities for residents. The plan of correction shall include the details of when and who is responsible to conduct the activities. The administrator will provide a copy of the plan of correction to CCL by 1/22/2026.

Type of visit: Case Management - Other

On 12/15/2025, Licensed Program Analyst (LPA) Yi Sam Jian arrived at the facility to deliver amended copy of LIC9099 for complaint number 14-AS-20250618092722. LPA met with staff Alicia Monton(S1), LPA explained the purpose of the visit. Administrator Nancy Uy(S3) was contacted over phone and gave permission for Staff S1 to sign required paperwork. This report was reviewed with staff S1 and copy was provided to facility.the state’s words, verbatim · CDSS document, Dec 15, 2025

Type of visit: Case Management - Other

On 11/06/2025, Licensed Program Analyst (LPA) Yi Sam Jian arrived at the facility to deliver amended copies of LIC9099. LPA met with staff Gloria Rodrin(S1), LPA explained the purpose of the visit. LPA spoke with Administrator Nancy Uy(S3) who stated that she could not make the visit and gave permission for Staff, Gloria Rodrin(S1) to sign required paperwork. Reports were reviewed with administrator and copies were provided to facility.the state’s words, verbatim · CDSS document, Nov 6, 2025

Type of visit: Case Management - Deficiencies

On 10/29/2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management visit to follow-up with the observations while conducting the 10-day complaint visit, LPA met with caregiver, Gloria Rodrin and explained the purpose of the visit. The administrator was contacted by the caregiver via phone. During the complaint visit ( 14- AS-20251020093609), LPA observed Staff #1(S1) was assisting residents and staff #2(S2) came into the facility from the garage. LPA checked S1 and S2's personnel records and observed S2 did not have a criminal record transfer. LPA interviewed the administrator who stated that S2 is a gardener and S2 started working at facility 2 days ago, LPA interviewed S1 who stated that S2 started working at the facility since last Thursday. LPA interviewed S2 who stated that he/she started working at the facility yesterday. LPA interviewed resident #1 (R1) who stated that S2 has been working at the facility for a few months. During the visit, LPA observed S2 was working in the kitchen and resident was calling S2's name for assistance but S2 stopped working when it was observed by LPA that he/she did not have a criminal record transfer. In addition, LPA observed staff #3(S3) who worked twice a week did not have criminal record clearance nor a criminal record transfer and according to the administrator, S3 has been working at the facility since 2024. During today's visit, LPA also observed the TV in the living room was not able to play any channels. S1 was able to turn on the TV but there was no channels. According to Resident #2 (R2), the TV has not been working for months. A civil penalty in the amount of $1500 is being assessed today; $500 for no criminal record clearance for S3 and $1000 for no criminal record transfer for S2 and S3. Deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. This report is reviewed and discussed with caregiver and administrator over the phone.. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 29, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Oct 30, 2025

87355 Criminal Record Clearancee (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by based on observation, record review and interview, S3 has been working at the facility since 2024 without a criminal record clearance which poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: The administrator stated that S3 will be removed from duty until criminal background and transfer processes are completed. The Licensee will provide a plan of correction indicating the process and the date to complete S3's criminal background process. The POC will indicate the facility's staffing plan to ensure sufficient staffing at all times. The POC shall also include what is the facility's process to ensure this does not happen again. The licensee will provided a copy of the plan and a copy of an updated LIC500 to CCL by 10/30/2025. A civil penalty of $500 is being assessed today.

From the deficiency page — Deficiency type: Type A · Section cited: CCR83755(e)(3) · Plan of correction due date: Oct 30, 2025

87355 Criminal Record Clearancee (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance.. This requirement is not met as evidenced by based on observation, record review and observation, S2 and S3 did not have a transfer of criminal record clearance which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: The licensee will submit a plan of correction indicating what is the facility's plan to ensure S2 and S3 will complete the transfer of a criminal record clearance process and the date of completion. The plan of correction shall include the plan to ensure this does not happen again. The Licensee will provide a copy of the plan of correction by 10/30/2025. A civil penalty of $1000 is being assess for S2 and S3.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 10, 2025

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, and interview, the TV in the living was not been working for months which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: The licensee will submit a plan of correction indicating the plan to ensure the TV in the living will be in good working condition and will submit a copy of the plan to CCL 11/10/2025.

Allegation investigated: -Staff physically abused resident

THIS IS AN AMENDED REPORT FROM AN ORIGINAL REPORT DATED 08/26/2025. On 08/26/2025, LPA conducted an unnannounced continue complaint investigation into the allegation that staff member S2 physically abused resident R1. LPA met with staff Gloria Rodrin(S1), LPA explained the purpose of the visit. LPA spoke with Administrator, Nancy Uy, who stated that she could not make the visit and gave permission for Staff S1 to sign required paperwork. LPA conducted interviews, and reviewed documentation during the visit. CONT. TO 9099C Unsubstantiated THIS IS AN AMENDED REPORT FROM AN ORIGINAL REPORT DATED 08/26/2025. Resident R1 reported that staff S2 had pushed R1 and handled R1 roughly. R1 also stated that S2 returned to the facility briefly after being terminated but has not been seen since. No witnesses or physical evidence were provided to corroborate the allegation, and no injuries were reported or observed. The alleged incident occurred in the bathroom with only S2 and R1 present. No other residents were interviewed, as they were not witnesses to the event. Administrator stated that S2 had worked at the facility for approximately six months and that no prior complaints had been made against S2. Administrator reported no visible injuries or unusual bruising on R1 at the time of the alleged incident and S2 denied the accusation when interviewed by administrator. Administrator reported that no incident report was filed regarding the alleged incident. Although the above investigations may have happened or are valid, based on the information obtained through interviews and record review, 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 staff S1. A copy is provided.the state’s words, verbatim · CDSS document, Aug 26, 2025 · control 14-AS-20250618092722

Type of visit: Required - 1 Year

On 6/13/2025, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Lead Caregiver, John Guintu. Licensee, Nancy Uy was notified of the visit but was not able to attend. The facility currently provides care for 3 residents none of which with a current 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 located in the kitchen was found to be charged. Smoke detector were observed in resident bedrooms tested. LPA observed a carbon monoxide detector in the hallway to be non-functioning and in need of replacement. 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. There was a supply of hygiene products and paper products available for residents. Resident's bedroom have lighting & appropriate furnishings and bedding items. Restrooms for resident use were equipped with non-slip mats, grab bars and kept in good condition. There is a large outdoor patio equipped with appropriate shading for resident use. LPA conducted a sample file review for residents found that 2 of 3 residents do not have physician's reports on file and 1 of 3 residents does not have a needs & service plan on file. Upon a sample review of staff files LPA found that 1 of 2 caregiver staff do not have current 1st aid & CPR certification on file. Upon interview with resident (R1), it was stated that the facility staff do not provide any supplies for activities or engagement. LPA observed an unplugged television in R1's room and found that the television is not connected to basic television channels compared to other residents in care. R1 stated that they aren't encouraged to participate in any exercise or activities while under the facility care. Continued onto LIC809-C LPA will return at a later date for the purpose of an annual continuation visit to review medications, staff training and emergency response records. Administrator, Nancy Uy is in the process of updating their administrator certification Acting Administrator, Joanna Casandra Uy's administrator certificate 7035656740 is valid through 9/29/2026 LPA requested the following documents be sent to CCL by COB 6/20/2025: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Jun 13, 2025

Type of visit: Prelicensing

On June 14, 2024, at 9:00 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to complete the pre-licensing. LPA Calandra was greeted by Elizabeth Huliganga, Caretaker and explained the purpose of the visit. LPA Calandra asked Elizabeth Huliganga, Caretaker to call Nancy Uy and Jacqueline Melosantos, the applicants to see if they could join the visit but neither could. This inspection was to follow up on the corrections that needed to be made per initial pre-licensing inspection conducted on March 19, 2024. LPA toured portions of the facility to inspect the areas that required corrections. LPA observed and verified the corrections have been made as follows: - Screens in the backyard have been fixed/replaced As a result of inspection today, the pre-licensing area of concerns have been resolved. Pre-Licensing is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Elizabeth Huliganga, Caretaker and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jun 14, 2024

Type of visit: Prelicensing

On April 24, 2024, at 8:40 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct an unannounced follow up pre-licensing visit. LPA Calandra met with Jacquelyn Melosantos, and explained the purpose of his visit. On 3/19/2024, LPA Calandra conducted the initial pre-licensing visit and asked the applicant to address the following: -Ensure water temperature is lowered to between 105 and 120 degrees Fahrenheit -Remove hoist and other items on side of house -Remove nails from the backyard deck -Remove Aquarium in front of house -Ensure that all screens are in good repair -Ensure each bedroom has a chair and sufficient lighting -Ensure Carbon Monoxide detector is functioning On 4/22/2024, after the visit, Nancy Uy, Applicant notified LPA Calandra of the above being resolved. During the visit, LPA Calandra checked the hot water temperature which was measured at 105.7 degrees Fahrenheit. LPA Calandra also observed that the nails in the backyard, hoist, Aquarium, and other items have been removed by the Applicant. Each bedroom as of 4/24/2024 has sufficient light and chairs and the Carbon Monoxide detector is functioning. As a result of today's inspection, most of the areas of concern from the initial inspection have been resolved. LPA Calandra will return to follow up on the screens in the backyard that are not in good repair as of 4/24/2024. No deficiencies were cited during today's visit. This report was reviewed with Jacquelyn Melosantos, and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Apr 24, 2024

Type of visit: Prelicensing

On March 19, 2024 at 8:30 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Pre-Licensing visit. LPA Calandra was greeted by Liwayway Castro and explained the purpose of his visit. Administrator Nancy Uy, is out of the country and thus could not join the visit. Ms.Uy's daughter, Jacquelyn Melosantos joined later. LPA Calandra conducted a physical plant tour. The facility consists of 5 bedrooms, 2 bathrooms, a garage, staff bedrooms, laundry room, living room and kitchen. Water temperature was measured at 130 degrees Fahrenheit. Jacquelyn turned down the water temperature in the presence of the LPA. All bedrooms were observed to have sufficient lighting and the required furniture. All bathrooms were observed to have the required grab bars and anti-skid mats. The facility had linens on hand for clients that were observed to be in good condition. The facility has the required 7 days of non-perishables and 2 days of perishables on hand. The front yard, backyard, and hallways were observed to be free from obstructions. The fire extinguisher was observed to be fully charged and last checked on 7/7/2023. A component III was performed with the applicant. LPA Calandra asked the applicant to address the following: -Ensure water temperature is lowered to between 105 and 120 degrees Fahrenheit -Remove hoist and other items on side of house -Remove nails from the backyard deck -Remove Aquarium in front of house -Ensure that all screens are in good repair -Ensure each bedroom has a chair and sufficient lighting -Ensure Carbon Monoxide detector is functioning LPA will return to conduct a follow-up visit to ensure the above items have been addressed. The report was reviewed with Jacquelyn Melosantos. A copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Mar 19, 2024