Gold Coast Care Home

Type of visit: Required - 1 Year

At approximately 12:10PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by designee Alex Ordonez. Licensee Marie Lomboy was called and arrived at approximately 12:45pm. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with zero (0) Hospice residents currently in care, and is approved for all non-ambulatory residents. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 12:25 PM, LPA initiated a tour of the facility with Designee and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Facility's fire extinguisher was observed charged and last serviced 2/26. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility is in the process of upgrading bathrooms. Both bathrooms were observed functional, facility will ensure compliance regarding water temperatures. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. Continued LIC809C... Continued from LIC809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 8/26. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 1:00 PM LPA conducted a review of five (5) resident records. All required documentation present. At approximately 1:20 PM LPA conducted review of three (3) staff records. All required documentation present. At approximately 1:40 PM LPA and designee conducted a spot check of medication and medication records. Medication is centrally stored and locked. Rustom Neil Lomboy Administrator Certificate 7012119740 expires 06/06/28. Updated copies of the following documents shall be submitted to CCL by 10/22/2026: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC402 - Surety Bond LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Licensee, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Sep 22, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 10:00 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Alex Ordonez, Designee. Administrator was called and was unable to attend, Alex Ordonez is designated to sign and receive report. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for all non-ambulatory residents. At approximately 10:25, LPA initiated a tour of the facility with Designee and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguisher was observed charged and last inspected 3/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 118.5 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. Outdoor patio is fully covered, has a full table for residents use, and has multiple other seats available. During visit LPA observed residents making frequent use of the patio and seating area. Facility has an internet access device and internet available to clients in care, and the phone was tested no deficiency cited. Continued LIC809C... Continued from LIC809... Facility could not show evidence of emergency drills conducted in 2025 and staff confirmed no drills had been conducted (deficiency cited). LPA observed facility's infection control plan and emergency disaster plan no deficiency cited. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 10:50 AM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 11:10 AM LPA conducted review of two (2) staff records. Two (2) of two (2) staff were missing 20 hours required yearly training (deficiency cited). At approximately 11:40 AM LPA and Designee conducted a spot check of medication and medication records. Medication is centrally stored and locked. Rustom Neil Lomboy Administrator Certificate 7012119740 expires 6/6/26. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL by 9/10/2025: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC809D. Exit interview conducted with Designee, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Aug 11, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela conducted an unannounced Annual Required – 1 yr. inspection for this facility and met with Administrator, Neil Lomboy. The facility currently provides care for 6 non-ambulatory residents, one of whom is receiving Hospice services. There were 2 additional care staff on site at the time of inspection. LPA arrived at the facility and began the facility tour with staff, Alex Ordonez and Administrator arrived a few minutes later. Facility was at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged and serviced on 03/28/2024. Smoke and carbon monoxide detectors were tested and found to be in working order. Last emergency drill was conducted and documented by facility on 7/21/2024. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Facility also has extra food in a cabinet in the garage. Toxins are stored in a locked cabinet in the facility garage and under bathroom and kitchen sinks and found to be secured. There was a supply of hygiene products and paper products available for resident use. All residents bedrooms have lighting & appropriate furnishings. Water temperature was measured at faucets accessible to residents and was measured between required regulation of 105 and 120 degrees F. LPA reviewed 6 resident files and they were found complete. LPA reviewed medication with administrator. Care staff have current CPR and 1st Aid training on file and the required training. Administrator certificate for Neil Lomboy, #6040644740 expired 6/6/2024 and it was renewed and waiting for new certificate. LPA observed live-in staff bedroom to be locked and secured. LPA went over the complaint poster PUB475 the facility has in the wall needing to be size 20X26 and administrator will post the correct size and notify LPA. Continue report see LIC809-C Facility informed LPA they have qualified for a Community Care Expansion Grant and will be receiving some renovations including flooring, bathroom upgrades and kitchen cabinets. LPA and Administrator went over facilities responsibility to notify CCL with a written plan regarding the renovations being done, expected time of completion and safety measures taken to insure the health and safety of residents in care during the renovation. LPA requested the following documents be sent to CCL by 11/15/24: LIC 9020 Register of residents LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary Copy of Certificate of Liability Insurance Lease Agreement No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Oct 18, 2024