Coastal Woods Homecare

Type of visit: Required - 1 Year

On 07/14/2026 at 12:51PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Jeffrey Bontog, Caregiver and explained the purpose of the visit. Administrator, Jonjie Ligaray arrived at approximately 1:25PM. Administrator currently holds certificate #6075194740 that expires on 12/25/2027. Fire clearance was approved for five (5) non ambulatory and One (1) bedridden resident. LPA toured facility with Jeffrey Bontog, caregiver, including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of five (5) bedrooms, one (1) bedroom occupied by staff, two and two bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 105.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7-day supply of nonperishable and 2 days of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased on 04/10/2026. First aid kit was observed to be complete. Fire drill was last conducted on 06/07/2026. Emergency disaster plan reviewed on 01/05/2026. Continued on LIC809C…. Continued from LIC809 LPA reviewed five (5) staff records, S3 was missing health screen/TB and four (4) out of five (5) staff were missing initial trainings. LPA reviewed all six (6) residents records and they were all current and complete.. LPA requested the following documents to be submitted to CCLD by 07/21/2026. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Updated Facility Sketch LPA observed the following deficiencies during visit: At 1:26PM, LPA observed during facility tour, facility has made alterations in the garage adding an additional staff room. At 3:26PM, LPA observed during file review, S3 does not have a Health Screen/TB. At 3:46PM, LPA observed four(4) out of five (5) staff members were missing initial trainings. Deficiencies were cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided to Jonjie Ligaray.the state’s words, verbatim · CDSS document, Jul 14, 2026

Type of visit: Post Licensing

On 10/07/2025 at 1:40PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced post licensing inspection. LPA met with Administrator Jonjie Ligaray and advised on the purpose of the visit. Fire clearance was approved for five (5) non ambulatory and One (1) bedridden resident. Upon entry LPA observed two (2) residents in common area sitting in recliner chairs and one (1) caregiver preparing meal for residents in care. LPA toured facility including but not limited to bedrooms, bathrooms, dining area, living room, kitchen, garage, and outdoor area. The fire extinguisher was observed to be full and last purchased on 01/09/2025. Medications were in a locked cabinet. Comfortable room temperature is maintained at 74 degrees F. Hot water temperature in the shared residents’ bathroom was measured at 111.7 degrees Fahrenheit. Carbon monoxide and smoke detectors were observed in operating condition. The first-aid kit was complete, and hygiene items for resident general use are sufficient. Extra linens and towels were observed. Last fire drill was conducted on 10/07/2025. There are no accessible bodies of water observed. Continue on LIC809C Continued from LIC809 LPA reviewed two (2) residents’ records, and three (3) staff records and they all were complete. The following forms are to be updated and submitted to CCL by 10/14/2025: LIC 500- Personnel Report LIC 308- Designation of Facility Responsibility LIC 610E- Emergency/Disaster Plan (9 pages) Evidence of Liability Insurance LIC9020 Residents Roster No deficiencies were observed during today's visit. Exit interview conducted and a copy of this report provided to Jonjie Ligaray.the state’s words, verbatim · CDSS document, Oct 7, 2025

Type of visit: Prelicensing

On 05/21/2025 at 10:45AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection. This is a continuance from the previous visit conducted on 05/14/2025. LPA met with Licensee, Carmela Flores and Administrator,Jonjie Ligaray and explained the purpose of the visit. On 05/14/2025 at 3:10PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced Pre-licensing Inspection. LPA met with Licensee, Etinne Demarly and Administrator, Jonjie Ligaray. LPA toured facility including but not limited to resident's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPA observed lighting in all rooms. LPA observed facility had some perishable and non-perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Carbon monoxide detector was observed in operating condition. First aid kit was complete. Emergency disaster plan was complete. Continue on LIC9099C Continued from LIC9099 On 05/21/2025 LPA toured the facility and observed Licensee/Administrator made corrections from previous visit on 05/14/2025. LPA Conducted COMP III on 05/21/2025. The licensee/administrator was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first resident. This notification may be done by phone, by mail, email, or by fax. No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 21, 2025

Type of visit: Case Management - Other

On 05/21/2025 at 11:15AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived to conduct an announced Case Management COMP III visit. LPA met with Licensee, Carmela Flores/Administrator, Jonjie Ligaray and explained the purpose of the visit. LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participants gained knowledge about running and maintaining the facility in accordance with regulations. A license has not yet been granted to this facility. Licensure is subject to final review and approval by the Centralized Applications Unit. Licensee is not to accept consumers until notified by Community Care Licensing that the license has been approved. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 21, 2025

Type of visit: Prelicensing

On 05/14/2025 at 3:10PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced Pre-licensing Inspection. LPA met with Licensee, Etinne Demarly and Administrator, Jonjie Ligaray. LPA toured facility including but not limited to resident's bedrooms, bathrooms, living room, dining area, kitchen, garage, and outdoor area. LPA observed lighting in all rooms. LPA observed facility had some perishable and non-perishable food supply. Licensee will purchase additional food supplies once facility is licensed. Carbon monoxide detector was observed in operating condition. First aid kit was complete. Emergency disaster plan was complete. The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB): Continue on LIC809C Continued from LIC809 The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB): 1. Hot water was measured at 121.5 degrees F in the common bathroom sink. 2. LPA observed facility does not have complete bedding, mattress pads, fitted sheet, flat sheet and blanket for all resident beds. 3. LPA observed facility does not have an exit sign in the backyard identifying emergency exit. 4.) LPA observed facility does not have a designated location to lock sharps. 5.) LPA observed facility has a lock on the pantry door where nonperishable foods are located. 6.) LPA observed facility does not have a dementia care plan to address behaviors such as ingestion of toxic chemicals and wandering behaviors. Licensee/Applicant will submit proof of corrections to CCLD on/before 05/. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 6, 2025