Aging in the Bay 2

Type of visit: Required - 1 Year

At approximately 10:15, Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection visit. LPA was greeted by designee/caregiver Mary Ann Ordono. Administrator Charmaine Mendaros arrived shortly later. Facility is a Residential Care Facility for the Elderly that has a fire clearance approved for six non-ambulatory residents and one bedridden in rooms 1,2,4 and 5 only. Approved hospice waiver for 5 residents. LPA toured the building and grounds which was found to be clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 2/14/2025. Fire alarms and carbon monoxide detector were tested and operational. Outdoor emergency exit clear from obstruction. Water temperature measured at 116.4 degrees F at faucets accessible to residents which is within the allowable range of 105 to 120 degrees F. Disaster drills are conducted quarterly with the last drill conducted on 10/01/2025. All bedrooms were equipped with lighting, a night stand and chest of drawers. Resident bathroom lacked bath mat, grab bar was observed (Technical Advsory given). LPA observed plastic mat in shared resident room #2 to be lifted and have ripping, presenting a tripping hazard to resident (Technical Violation given). LPA observed a Fire Clearance Violation as closet in shared room 1 and 2 to be occupied for live in staff. Mattress with bedding, personal items and camera was observed inside residents closet (Deficiency Cited, see 809D) **Immediate Civil Penalty assessed in the amount of $500 due to fire clearance violation. LPA had conversation about the importance and potential dangers of having an unapproved room. Mattress was removed during inspection. Continued onto 809C... continued from 809.... LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Emergency water was observed to meet the 72 hour emergency supply, however emergency food was not observed. LPA advised admin to supply more non-perishables for emergency (Technical advisory given). Facility kitchen, refrigerators and freezers were clean, and food was stored properly with expiration dates noted. LPA observed ants to be in pantry not inside food. However, admin stated Pest Control comes monthly for treatment. LPA verified through receipts. Toxins are stored in a locked cabinet and inaccessible to residents. Sharps and knives were locked in kitchen drawer. Facility had an ample supply of linens, towels and extra hygiene products for residents. LPA reviewed 6 of 6 resident records. All required documentation was present. Physician reports were up to date. LPA reviewed 5 staff records. LPA observed CPR Certificate number that belongs to staff (S1) no longer working at facility to be the same number for S2, S3 and S4. LPA verified CPR Certification on website and verified that S1 certification belonged to S1 only. CPR certification number for S5 was not found in website. CPR for S6 was expired as of 10/03/2025 also appeared to have the same certification number as S1,S2,S3 and S4 (Deficiency Cited, see 809D). LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308-Designation of Responsibility (Retrieved during visit) Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and report read with Administrator.the state’s words, verbatim · CDSS document, Oct 27, 2025

Type of visit: Collateral

Licensing Program Analyst (LPA), Star Stevenson arrived unannounced at Aging in the Bay 2 for the purpose of conducting a Collateral case management visit. Upon arrival, LPA was greeted at the door by caregiver Butch Apalisoc, who called Licensee/Administrator Charmaine Mendaros and Administrator for Aging in the Bay 2, Mary Ann Bernardo. Mary Ann Bernardo arrived at approximately 10:30 AM to help with collateral visit. LPA collected documents and conducted interviews of four (4) residents and inspected the records of three (3) hospice residents. No Deficiencies were observed or cited during this Collateral inspection. Exit interview was conducted and a copy of this report was given to Administrator.the state’s words, verbatim · CDSS document, Oct 14, 2025

Type of visit: Required - 1 Year

At approximately 10:30 AM, Licensing Program Analysts (LPAs) Julie Florio and Robert Frank arrived unannounced to conduct a required 1-year annual inspection and were greeted by Mary Ann Ordono, Caregiver/Designated Responsible Party (DPR). Charmaine Mendaros, Administrator was contacted via telephone, gave LPAs permission to begin inspection with DRP, and Administrator arrived approximately one (1) hour later at 11:30 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. All residents were present during today's inspection. Facility has a hospice waiver for five (5), a bedridden waiver for one (1), is approved for all non-ambulatory residents, and currently has three (3) hospice residents in care. At approximately 10:50 AM, LPAs initiated a tour of the facility with DRP and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPAs observed a lock installed near the top of the front door of the facility and advised Administrator to ensure that all facility exterior doors remain in compliance with regulation for a facility not approved for a secured perimeter unless otherwise approved by The Department, (see LIC809D). Administrator removed the lock immediately. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens and hygiene, paper and incontinent care products available to residents. Residents' bedrooms were inspected and observed to have the appropriate furnishings as outlined in Title 22 regulations. LPAs observed mouse droppings in the food pantry and an activated mouse trap in resident bedroom 3, (see LIC809D). Cabinets containing cleaning supplies and other items that could pose a risk were locked. However, LPAs observed the key used to unlock said cabinets hanging on a hook in the kitchen where accessible to residents in care, (see LIC809D). Facility has at least two days of perishable food and an emergency water supply. Continued on LIC809-C... Continued from LIC809C... LPAs advised administrator to increase the amount of non-perishable food/emergency food to ensure facility has at least a one week supply. Additionally, LPAs observed several perishable food items transferred into storage containers that were not labeled with the item name, expiration date, or open date, (see LIC809D). Medications were centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. LPAs observed a missing screen door and at least two window screens in disrepair, (see LIC809D). LPAs observed an activity schedule and games, puzzles, and activities for residents in care. Facility hosted their holiday party last night for residents in care. Administrator agreed to purchase an additional internet access device which will be dedicated for resident use and facility has internet service available to residents in care. The facility telephone was tested an operational during inspection. Facility's fire extinguisher was observed charged and was last serviced February 2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts quarterly disaster drills, and the most recent drill was conducted 10/2024. LPAs observed the facility's infection control plan, first aid kit, PPE, and other emergency supplies. LPAs reviewed facility's emergency disaster plan last updated 11/2021. At approximately 12:30 PM, LPAs reviewed five (5) staff files which all contained the required paperwork including the required CPR and First Aid training certificates. However, Staff 1 (S1) and Staff 2 (S2) were deficient in proof of completed initial training hours, (see LIC809D). LPAs conducted file review of all six (6) resident files and observed two (2) or more of the required documents either missing or not signed and dated from each file, (see LIC809D). LPAs advised Licensee to ensure all documents are complete, signed, and dated. At approximately 3:00 PM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation. However, LPAs observed expired medications, (see LIC809D). Licensee states facility coordinate sresidents' medical and dental appointments and coordinates their transportation to and from visits with residents' family or a third party transportation service. Facility does not manage cash resources for residents. Continued on LIC809C... Continued from LIC809C... Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC610 Emergency Disaster Plan (updated) LIC500 Personnel Report (updated) Proof of Current Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted with Administrator and Appeal rights were given. Signature on form confirms receipt.the state’s words, verbatim · CDSS document, Dec 20, 2024

The state marks this report as 12 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Aging in the Bay 2 for the purpose of conducting a Case Management-Annual Continuation. LPA was greeted at the door by Back-up Administrator/Caregiver, Mary Ann Ordono and was granted access into the facility. Administrator, Charmaine Mendaros arrived 1 hour later. Upon checking background clearances, LPA observed that Back-up Administrator/Caregiver, Mary Ann Ordono was not associated to the facility (See LIC 9102-Technical Violation). LPA educated the Administrator regarding associating new employees. During this Case Management-Annual Continuation, LPA reviewed resident and staff records. Resident and staff interviews were conducted. Medication Orders were reviewed. LPA observed during the review that a resident had the label of the medication ripped off (See LIC 812-Observation). LPA educated the Administrator regarding labels on medications should be clearly read and identifiable to the medication, dosages and prescribing physician (See LIC 809D). During record review, LPA observed that 2 out of 4 residents did not have Reappraisals conducted yearly as outlined in Title 22 regulations (See LIC 809D). LPA educated the Administrator regarding the importance of conducting reappraisals annually as outlined in Title 22 regulations. LPA requested the following documents to be sent: LIC 500-Personnel Report, LIC 308-Designation of Responsibility, Liability insurance, Control of Property, Client Roster and Staff Roster Deficiencies 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. Exit interview was conducted, and a copy of this report was signed and given to the Administrator.the state’s words, verbatim · CDSS document, Nov 28, 2023

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Aging in the Bay 2 for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Caregiver, Dionisio Apalisco , and was granted access into the facility. Administrator, Charmaine Mendaros arrived 1 hour later. LPA toured the facility. LPA observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on February 2023 at the time of the inspection. All smoke detectors and carbon monoxide detectors were tested and found to be operational during the inspection. Water temperature in 2 of 2 residents bathroom measured at 116 degrees, and is within acceptable range of 105 to 120 degrees F. There was sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Activities Menu was also posted. Medications were centrally stored and locked. Cleaning products and other toxins are located in the laundry room that was locked and inaccessible to residents in care. There was a supply of Linens, cleaners, hygiene products and paper products available for residents All bathrooms designated for residents in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of all residents bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. Resident Records, Staff Records, Resident and Staff interviews will be conducted at a later date and time. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Emergency Disaster Plan was reviewed. Quarterly Disaster Drill was conducted. No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was given to the facility Administrator.the state’s words, verbatim · CDSS document, Oct 30, 2023