An Elite Chateau

Type of visit: Required - 1 Year

On 05/04/26, at 9:10am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA met with Sean Abalajon, Assistant Administrator. LPA asked for the census, resident, and staff files. The facility is a two (2) story home that has a total of nine (09) bedrooms and five (05) bathrooms. Fire Clearance is approved for four (04) ambulatory, one (1) non-ambulatory and one (1) bedridden and the facility has a hospice waiver for six (06) residents. There is an upstairs that is not part of the facility which has two (2) bedrooms and one (1) bathroom. There is an ADU-Accessory Dwelling Unit that is part of the facility sketch. Kitchen is sufficiently stocked with at least seven (07) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. There are two (2) refrigerators in the kitchen. Kitchen cabinets contain extra food. Knives and sharps are observed to be locked and inaccessible to residents on your left side of one (1) of the cabinets. The medication is kept in the kitchen area locked and inaccessible to the residents also on your left hand side of one (1) of the cabinets. The toxins/chemicals are kept under the sink. There is one (1) washer and dryer located in the kitchen area. LIC 809C-continued Living Room and Dining Room: LPA observed the living room and furniture to be clean and in good repair. There is a a large television. The dining room area has several chairs for residents. The facility temperature is between 71 and 72 degrees Fahrenheit. There is other fire extinguishers in the hallway fully charged with an expiration date of 03/2026. Bedrooms: Facility has seven (7) bedrooms. Six (6) bedrooms are single occupied for residents. One (1) bedroom is for staff. Bathrooms: There are four (4) bathrooms that have proper grab bars, non-skid mats. The bathrooms contained a trash can with tight-fitting lid. Hot water was tested and measured between 107.1 F and 111.9 F within regulations. Two (2) bathrooms are shared and two (2) bathrooms are private. Outside/Backyard: The outside/backyard has furniture for residents. There is a pool that is locked and inaccessible to residents. There is also a shed in the backyard. Last fire drill/Fire Alarms were conducted on 04/01/2026. The living and dining room are neat and clean. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. The facility has several fire extinguishers throughout the house. There are three (3) fire extinguishers located in the kitchen, observed to be full and last purchased on 03/2026. There are cameras in the common areas. There is a signal system in the house. Administrative: The administrative Certification is current and expires 06/28/2027. There is a yes sign, Ombudsman, Personal Rights and Emergency Disaster Plan that expires 02/02027, Rights of Resident Council, Emergency Numbers against the wall of the facility on your left-hand side of the back of the facility. The liability insurance expires 03/05/27. Staff/Resident Files: LPA reviewed six (6) resident files and three (3) staff files. An exit interview was conducted, no citation(s) were issued and a copy of this report was given to the assistant administrator.the state’s words, verbatim · CDSS document, May 4, 2026

Allegation investigated: Staff did not ensure there is sufficient foods at the facility for residents in care

Licensing Program Analyst (LPAs), Mariana Agban and Evelin Rios conducted an unannounced initial complaint visit to investigate the above stated allegation. LPAs met with the Assistant Administrator Sean Draeco Abalajon and explained the reason for the visit. LPAs conducted a physical plan tour to ensure the health and safety of residents are protected and comply with Title 22 Regulations. LPAs requested copies of the staff roster, residents roster, food menu, and other documents pertinent to the investigation. Allegation: Staff did not ensure there is sufficient foods at the facility for residents in care It was alleged that the facility's fridge ran out of food. Interviews with 5 out of 6 residents denied the allegation. LPA also interviewed 4 staff who also denied the allegation. Although residents and staff interviews denied the allegation, LPAs did not observe sufficient food supplies for nonperishable foods for a minimum of one week and perishable foods for a minimum of two days on the premises. (Continue on 9099C) Substantiated Interview with the Assistant Administrator included statements that staff go grocery shopping weekly and every other day for any special requests from the residents. Based on information obtained, the allegation that Staff did not ensure there is sufficient food at the facility for residents in care is deemed Substantiated at this time. Exit interview conducted, citation issued, appeal rights given, and copy for this report signed and delivered. Allegation: Staff engaged in inappropriate interactions with resident in care It was alleged that staff smacked residents in care and made inappropriate comments. Interviews with 5 out of 6 residents denied the allegation. LPAs also interviewed 4 staff members, who also denied the allegation. Assistant Administrator stated included statements that such behaviors are unacceptable at the facility. Based on information obtained, the allegation is deemed Unsubstantiated at this time. Allegation: Staff solicited money from residents in care It was alleged that staff were soliciting money from residents in care. Interviews with 5 out of 6 residents denied the allegation. LPAs also interviewed 4 staff who also denied the allegation. Residents' interviews included statements that staff did not solicit money and were satisfied with the services and care provided by the staff. Based on information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of this signed and delivered.the state’s words, verbatim · CDSS document, Oct 29, 2025 · control 31-AS-20251024154115

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Oct 31, 2025

(b) The following food service requirements shall apply: (26)Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Based on LPAs' observations, there were no sufficient food supplies for nonperishable foods for a minimum of one week and perishable foods for a minimum of two days on the premises. This poses a potential health, safety, or personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: The Assistant Administrator will purchase sufficient food supplies for nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Proof of groceries will be sent to the LPA by the POC date.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPA’s) Mariana Agban and Evelin Rios conducted a Case Management - Deficiency visit in conjunction to Complaint Control Number 31-AS-20251024154115. LPAs were granted access by caregiver and met with Assistant Administrator, Sean V. Abalajon shortly after. LPAs explained the reason for the visit. During the physical plant inspection, LPA Rios observed medications stored in two (2) of the six (6) resident bedrooms. A review of all six (6) residents’ records revealed that Resident #2’s (R2’s) Physician’s Report (LIC 602) indicates R2 as unable to manage or store their own medications. Resident #3 (R3) had an incomplete LIC 602 that did not specify whether they are capable of storing their own medications. In an interview, the Assistant Administrator stated that R2 “chooses” to keep their medications, and there for the facility allows it. They also informed LPA Rios that R3 has a diagnosis that could pose a health and safety risk if R3 were given access to their medications. During the physical plant tour, LPA Rios observed a medication organizer in R2’s bedroom, as well as another organizer in the facility’s medication cabinet. Several small containers filled with various pills were also observed. According to the Assistant Administrator, medications for Residents #1 (R1) and R2 are arranged in weekly organizers due to the volume of medications they require. For the four (4) other residents, medications are placed into small containers labeled “AM” and “PM” to provide scheduled medication. A review of the facility’s medication management policy revealed that all medications are required to be locked, centrally stored, and kept inaccessible to residents. Additionally, the policy states that medications must be prepared by staff in a medication cup one hour prior to administration, in accordance with physician orders. (Continue to LIC809-C) (Continued from LIC809) During the backyard physical plant inspection, LPAs observed that two gates providing access to a filled pool were unlocked and left open. In an interview, the Assistant Administrator revealed that the facility had hosted a gathering about three weeks ago and had forgotten to close the gates since then. An interview with the Assistant Administrator revealed that R3 began receiving hospice services following an incident that required emergency medical attention. However, a review of the Woodland Hills Regional Office files by LPA Rios showed that no incident report had been submitted regarding this event. The Assistant Administrator was uncertain about the date of the incident, and R3’s hospice folder lacked documentation indicating the start of care. Additionally, the LPA was unable to locate a Hospice Notification. Deficiencies cited (Refer to LIC809-D). Exit Interview Conducted / A Copy of the Report was provided to Assistant Administrator.the state’s words, verbatim · CDSS document, Oct 29, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(e)(2)(A) · Plan of correction due date: Oct 30, 2025

(e) The licensee shall supervise residents as needed... when there is use of the following items: (2)...swimming pools...(A) The licensee shall ensure... are inaccessible... when not in active use by residents. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in allowing access to a pool from two gates when not in active use by residents which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: Assistant administrator closed the gates during visit and agreed to submit a picture with the gate locked with a chain to LPA by POC due date 10/30/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(5) · Plan of correction due date: Nov 14, 2025

(h) The following requirements shall apply to medications which are centrally stored:(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above six (6) out of (6) resdients having medication transfered between containers which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: Medication organizers shall be removed and residents medication shall be stored in their originally received containers. Assistant Administrator agreed that all staff responsible for providing residents with medication assistance of self administration will complete medication training and submit sign in sheet with training material covered to LPA by POC due date 11/14/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Oct 30, 2025

h)The following requirements shall apply to medications...(1) Medications shall be centrally stored under the following circumstances: (C) Because of potential dangers... due to physical arrangements in the facility and the condition or the habits of other persons in the facility... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in two (2) out of (6) residents storing medication in their bedrooms which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: The facility will centrally store all medications as indicated in their Program. Assistant Administrator will notify LPA that the medication will be centrally stored.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Oct 29, 2025

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to...the following: (1)A written report shall be submitted to the licensing agency...This requirement is not met as evidenced by: This requirement is not met as evidenced by: Based record review and interview, the licensee did not comply with the section cited above in one (1) out of (6) residents had a medical emergency and then started Hospice Services without notification or report submitted to Licensing which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: The assistant administrator agreed to submit incident report and statement of understanding for the regulation cited to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(h)(1) · Plan of correction due date: Nov 14, 2025

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment.(1)Documentation of the annual routine visit... added to the resident's record. Based on interviews and record review, the licensee did not comply with the section cited above 1 out of 6 residents having an LIC602 form 2023 even with a change in condition and diagnoses which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: Assistant Administrator agreed to schedule R3 for a medical assesment and obtain an updated LIC602 and submit a copy to LPA by POC due date 11/14/2025.

Type of visit: Required - 1 Year

At 9:45a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with Caregiver and explained the reason for the visit. Later, Assistant Administrator joined today’s visit. At 10:15a.m., Caregiver and LPA conducted physical plant tour inside and out. During the tour, LPA observed that the facility is a home located in a residential community. The front main door is the only entrance being utilized at the facility, it has six (06) bedrooms and three (03) bathrooms designated for residents and two (02) staff bathroom. Six (06) private bedrooms and three (03) bedrooms designated for live – in staff, and two (02) bedrooms for Administrator’s son and daughter. Three 03) bedrooms designated for the staff is located on the second floor of the facility, which is only accessible by spiral staircase. Spiral staircase has a locked gate only accessible by the staff. Fire/Earthquake drill was last conducted on 03/01/2025. Required posting observed displayed in the facility hallway (complaint hot line poster, personal rights, etc). Temperature of facility wall thermostat is observed and set to 72 Fahrenheit. The fire alarm/CO system was tested and observed to be working, it is hard wired and interconnected. No obstructions and or tripping hazards throughout the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. Furniture in common area was observed to be in good repair. Residents dining table fits six (06) residents. (Continued to LIC 809-C) (Continued from LIC 809) Bedrooms were toured and observed to be clean and properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Linen storage was also checked and observed to have ample supply of clean linen, comforters, and towels in facility. Every bedroom, hallway area and kitchen has smoke/CO detectors that are functional. Bathrooms were observed to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range of 107.5°F to 116.9°F and within the required range. Resident’s personal hygiene supplied are kept separate in their private room. Towels and washcloths are not shared. Kitchen Area is observed to be clean and sanitary. Sharps are locked and stored in a cabinet in the kitchen. Toxins, cleaning solutions, and soap stored and locked under the sink. Laundry Room: LPA observed detergent, toxins and cleaning supplies washer and dryer machines located next to the kitchen and inaccessible to residents in care. Fire extinguishers were observed to be located throughout the facility. Fire extinguishers were observed to be operable with service date 01/03/2025. Food: LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap and stored properly as well. Food storage and preparation areas are clean. Medication and first aid kit were observed to be locked in kitchen cabinet inaccessible to residents in care. Garage is detached to the house and observed to be locked and inaccessible to residents. Surrounding Grounds The front grounds of the facility are well landscaped. All passageways and stairways were observed to be clear from obstruction. The front porch is covered with chairs for lounging at the facility. The outdoor area was enclosed, and there is a pool in the backyard of the facility, which is gated and locked in the premises. Resident Records. Six (06) resident records were reviewed. Three (03) out of six (06) residents record did not have Physician’s Report. Staff Records were also reviewed Administrator’s son and daughter do not have criminal record clearances, associated to this facility. Administrator and Assistant Administrator cardiopulmonary resuscitation (CPR) and first aid training are expired. However, caregiver on duty CPR is current at the time of this visit. Administrator's certificate was observed to be current. Alteration to exciting facility physical sketch was observed, activity area was converted into son’s bedroom. Alteration was done without notifying Community Care Licensing. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed cited on LIC809-D during the visit. Exit Interview Conducted / A Copy of the Report was provided to Assistant Administrator.the state’s words, verbatim · CDSS document, Mar 24, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst(LPA) Antonia Alvizar-Ettima met with Assistant Administrator. An unannounced One (01) year required inspection visit was conducted to this facility. During inspection, LPA Alvizar-Ettima discovered the following Licensee/Administrator's son and daughter reside in the facility. They are not Background Clearance or Transferred and Association to this facility. Son and daughter have been residing at facility since 11/01/2024. LPA verified using Facility Personnel Report Summary, son and daughter names did not appeared on facility roster. Son - Sean V. Abalajon DOB: 04/07/2001 Daughter - Katrina V. Abalajon DOB: 09/20/2006 A citation and civil penalty were issued. Copy of this report was provide to Assistant Administrator, William Foy.the state’s words, verbatim · CDSS document, Mar 24, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Feb 24, 0873

Criminal Record Clearance. Prior to resi- ding or volunteering.. all individuals... a criminal record review shall obtain a clearance or ..exemption. During visit, LPA met with Administrator's son who is residing in the facility and indicated that his sister also lives here. Based on interview and review of Facility Personnel Report Summary Son & Daughter are not Criminal Background Clearanced or Transferred & Associated to this facility. No documentation has been submitted to CCLD. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Mar 24, 2025

Plan of correction: Assistant Administrator will ensure that residents completed Criminal Background Clearance or Transferred & Associated to facility. Staff will provide documents to LPA. Son exit the facility and will not return until transferred and Associated. Daughter was not present at the time of this visit.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an announced Pre-Licensing visit to this facility and met with Mary Jane McLeland, Administrator. Facility is fire cleared for three ambulatory, two non-ambulatory and one bedridden. Currently there are six residents in care. Visit was conducted on 03/07/2024. Component three was also conducted and completed on 03/07/2024. LPA was given a tour of the physical plant. Facility has seven bedrooms. Two bedrooms are designated for staff. Six bedrooms are private bedrooms. LPA observed all bedrooms to be appropriately furnished. There are five bathrooms. One bathroom is designated for staff. All resident bathrooms have grab bars and non skid mats. Hot water was observed by LPA and administrator to be at 120 degrees by using a thermometer. The facility smoke alarm system and carbon monoxide are operable. LPA checked the kitchen area for the ability to prepare and store food. LPA observed knives, sharp objects, and cleaning supplies to be locked away and inaccessible. Medications will be locked in kitchen cabinets. Emergency telephone numbers are on the kitchen wall along with other required posters. There is a working telephone on the premises. LPA toured all common areas. LPA observed the home to be clean and furniture to be in good condition. In the back of the home is a swimming pool that has a locked gate and is inaccessible to residents. LPA will notify Centralized Application Unit regarding component three being complete along with the pre-licensing visit having been conducted. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 7, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 Method: Telephone call with CAB COMP II Participants: Mary Jane McLelland, Administrator/Owner; Shannon Betker, analyst. 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, Nov 2, 2023