A Place Like Home 1

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Cheramy Tantiado and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 9:50AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 5-bedroom, 4-bathroom, two-story house with attached garage that is used for storage and an accessory dwelling unit with its own address in the backyard. There is a back yard with a patio cover for the residents. LPA and AD observed 1 staff and 4 residents present at the facility in addition to AD. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the one staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 113 and 114 degrees F in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees have not been paid but are not yet past due. At about 7:50AM, LPA reviewed 4 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 4 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on observation, the facility's fire extinguisher has not been serviced or replaced in over a year; based on records, Staff #2 (S2) does not have a health screening; based on documents, S2 does not have a current first aid certificate at the facility; based on documents, Resident #2’s (R2) appraisal has not been updated in over a year; based on observation and admission, the facility has two stories but does not have an evacuation chair; and based on admission, the licensee had a change in corporate structure more than 15 business days ago which was not reported to the Department. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Feb 5, 2026

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jerome Haley arrived to conduct an unannounced Case Management visit. LPA Haley explained the reason for the visit before entering the facility. After entering the facility, LPA was led on a tour of the facility with staff. There were three residents present at the time of the Case Management visit including Resident 1 (R1). All residents were observed during the visit, two residents were in their bedroom and one resident (R1) was in the living room sleeping. Staff was asked about R1 during the visit. Both staff present during the visit confirmed, R1 is a happy person, one staff described R1 as a “very lovely woman.” Staff explained R1 is very alert, likes to eat, and takes their medications. R1 gets along with all the staff and the other residents. R1 enjoyed her first bath at the facility. R1’s nephew has been in contact with facility staff and was here at the facility on Friday, March 7, 2025. Facility staff have not had any problems with the resident. Staff provided relevant documents for R1 and additional documents will be emailed to LPA Haley. No deficiencies are being cited as a result of today’s Case Management visit. An exit interview was conducted, and a copy of this report and LIC811 was provided.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Maria Avila, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on December 2, 2024. This is an initial application with no residents in care. During the inspection, LPA and AP observed the following: Structure: this is a two-story home. Facility is a 5-bedroom, 4-bathroom, 2 story house with an attached garage that is being used for storage. There is a back yard with a patio cover for the residents. Facility telephone number is (714) 591-5150. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lamps, chairs, linens, and storage for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 1 staff bedroom on the second floor. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 113 and 115 F degrees in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan, and Menu: reviewed. Food Service: 7 days nonperishable and 2 days perishable food supply reviewed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: inspected. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet is locked. First-Aid Kit and Activity Supplies: observed and available. Resident & Staff Files: this is an initial inspection and LPA observed storage space for resident and staff files. Fire clearance was approved by City of Garden Grove Fire Department on January 14, 2025 for 6 non-ambulatory. Backyard: backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. AP will obtain liability insurance once the application is approved. CONTINUED During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.the state’s words, verbatim · CDSS document, Feb 24, 2025