Aging Gracefully Care of Tri-City

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Elisa Que. Administrator Irene Palad arrived during the visit. The facility has a licensed capacity of 6 non-ambulatory residents and has a hospice waiver for 6 residents. As of 1/6/2026, the facility has a pending fire clearance request to increase the facility's capacity to 6 non-ambulatory residents, 1 of which may be bedridden. During today’s visit, the facility had a census of 5 residents. The Administrator for the facility is Irene Palad and their certificate was valid and current. During today’s visit, LPA inspected each room of the facility, including resident rooms, private and common bathrooms, kitchen, garage, common areas, and outside space. No bodies of water, delayed egress, or secured perimeter were observed on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. LPA observed linens and hygiene products for resident use. The facility’s ambient temperature was measured within regulatory requirements at multiple locations. The water temperature was measured at 130.8 degrees Fahrenheit in a common bathroom. Administrator Palad turned down the water heater during the visit. LPA observed locked storage for hazardous and/or toxic chemicals, which were stored separately from food supplies. Observation of the locked medication closet revealed that residents' daily medications were pre-poured into daily pillboxes. Additionally, review of the kitchen refrigerator revealed multiple medications which were not kept in locked storage. According to Irene Palad, no firearms or weapons are stored on the premises. Continued on LIC809-C page... LPA observed a minimum supply of 2-days of perishable food and 7-days of non-perishable food. The refrigerator and freezer temperatures were kept within requirements. Staff present at the facility had a criminal background clearance and association. LPA reviewed multiple resident and staff records. The following deficiencies were cited for unsecured medications, medications not stored in their original container, and hot water temperature and noted on the attached LIC809-D pages. An exit interview was conducted with Caregiver Elisa Que, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Mar 23, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rebecca Borunda conducted an announced case management visit to cite deficiencies observed during a complaint visit that are unrelated to the complaint allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Irene Palad. During the unrelated complaint visit, LPA reviewed resident records and determined that Resident 1 (R1) was unable to reposition in bed independently and was bedridden. [Administrator was provided with an LIC811 Confidential Names List to identify R1] Therefore, a deficiency regarding bedridden fire clearance is being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page. Additionally, a civil penalty in the amount of $500 is being issued on an LIC421IM form. An exit interview was conducted with Administrator Irene Palad, whose signature below confirms receipt of a copy of this report, LIC811, LIC421IM, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jan 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Jan 7, 2026

87202 Fire Clearance (a) ... Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance... (2) Bedridden persons This requirement has not been met as evidenced by: Based on record review, the Licensee did not comply with the section cited above in that R1 was bedridden and the facility does not have bedridden fire clearance. This poses an immediate safety risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Jan 6, 2026

Plan of correction: Administrator will submit an LIC200 and facility sketch requesting an increase in fire clearance to allow for 1 bedridden resident. Administrator will submit LIC200 and sketch to the Department by POC due date of 1/7/2026.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rebecca Borunda conducted an announced Pre-Licensing visit. LPA was met by Applicant Irene Palad and was granted entry into the facility. The purpose of today's visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 11/12/2024 and the facility is approved for 6 non-ambulatory residents. The facility has two staff bedrooms on the second floor of the building. During today's visit, LPA toured the facility and inspected every room. The facility was found to be clean, safe, and in good repair with no pathway obstructions. Private and common bathrooms were observed to be clean and the toilets and showers were found to be in working order. The facility's water temperature in bathrooms for resident and staff use were measured at 119.5 and 105.4 degrees Fahrenheit. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage for resident medications. Fire extinguishers were observed throughout the facility and found to be in compliance. A functioning carbon monoxide detector and smoke detectors were observed in the facility. No bodies of water were observed near or on the premises. LPA observed a 7-day supply of non-perishable food and a 2-day supply of perishable food. Required postings were observed in a common area of the facility. LPA reviewed facility’s Infection Control Plan and Emergency Disaster Plan. LPA conducted Component III with the applicant. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance. Pre-licensing is complete, and this facility has no deficiencies. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with the applicant, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Mar 10, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 5 Method: Telephone call with CAB COMP II Participants: Palad, Irene On 2/27/25, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 27, 2025