Ashley's Care Homes

Type of visit: Case Management - Annual Continuation

At approximately 9:45 AM Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to CONTINUE a required 1-year annual inspection and was greeted by caregiver Irene Llantero who has Designation of Facility Responsibly (RP) Licensee Omar Chiong was called and arrived at approximately 10:15 AM to further assisted with today's continued inspection. At approximately 9:55 AM LPA reviewed three (3) of 3 staff files and found that all 3 had required employment documentation as required by title 22. At approximately 10:40 AM LPA reviewed six (6) resident files and observed all 6 to have required documentation. Facility has a hospice waiver for three (3) residents and currently two (2) of six (6) residents are receiving hospice care with hospice care plans on file. At approximately 11:15 AM medicines were found to be centrally stored and secure and a record of their administration accurate. Facility does not handle resident cash resources. Facility is aware that an Emergency/Disaster Drill is to be performed every 3 months and last conducted a drill on 12/12/2025 Facility participated in Technical Support Services (TSP) as a newly licensed facility Continued on LIC809C Continued from LIC809 Licensee is asked to submit the following documents to update the facility file including: 1)LIC500 Personnel file by 03/22/2026 2)LIC9020 Resident Roster by 03/22/2026 3)LIC610D Emergency Disaster plan by 03/22/2026 4)Updated Liability Insurance by 08/22/2026 Report was reviewed with licensee whose signature here denotes receipt.the state’s words, verbatim · CDSS document, Feb 23, 2026

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 1:10 PM, Licensing Program Analyst (LPA) Star Stevenson arrived announced to BEGIN a required 1-year annual inspection and was greeted by caregiver Irene Llantero who has Designation of Facility Responsibility(RP). RP called licensee Omar Chiong who arrived at approximately 1:30 PM to assist with today's portion of the annual inspection. Facility is a Residential Care Facility for the Elderly (RCFE) licensed for six (6) residents, 6 of which can be non-ambulatory with a hospice waiver for three (3). Currently there are six (6) residents in care, two (2) of which are receiving hospice services. At approximately 10:15 AM, LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Kitchen was observed to have locked drawers for sharps and toxins and the storage of foods were appropriated. Smoke detectors and Carbon Monoxide detectors were tested and found to be operational. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. Bathroom were observed to have grab bars and locking drawers for toxins LPA observed a supply of clean linens, hygiene products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. continued on LIC809C Continued LIC809C Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Facility has a designated combination locked closet with an automatically closing door, as well as locked drawer and cabinet for centrally stored medications and resident, staff, and facility files. LPA observed first aid kit, PPE, other emergency supplies, activity schedule, and games available for resident use. Licensee was advised at a later unannounced date to complete the annual inspection including: observation of staff and resident files and medicine administration. No deficiencies are being cited. Inspection was was reviewed with licensee whose signature confirms receiptthe state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: Post Licensing

At approximately 9:45 AM, Licensing Program Analyst (LPA) Star Stevenson arrived announced to conduct a post-licensing inspection and was greeted by administrator Omar Chiong. Facility is a Residential Care Facility for the Elderly (RCFE) licensed for six (6) residents, 6 of which can be non-ambulatory with a hospice waiver for three (3). Currently there are Three (3) residents in care. At approximately 10:15 AM, LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed resident showers now have shower curtain rods and curtains and non-slip mats and grab bars are in place. LPA observed a supply of clean linens, hygiene products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Facility has a designated locked closet, as well as locked drawer and cabinet for centrally stored medications and resident, staff, and facility files. LPA observed first aid kit, PPE, other emergency supplies, activity schedule, and games available for resident use. LPA continues to recommended that applicant add additional, age appropriate activities for elderly residents like puzzles, hangman, crafts, music, coloring, pet visits, music visits etc. Facility has a fire extinguisher, which was last inspected 10/2024 and is fully charged and licensee was advised to arrange for re-inspection and tagging soon. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on LIC809-C... ..continued from LIC809... The backyard now has level walkways and a shaded patio area and seating for resident use. A large and heavy stone counter top was observed to be leaning against a locked shed and licensee was advised to lay it flat on the ground or remove it to reduce potential risk to residents or staff in the event the stone fell over. LPA conducted a review of five (5) of 5 staff records and three (3) of 3 resident records. Four (4) of five (5) staff files were missing paperwork with S1, S2, S3, S4 had no evidence of 40 hours of training and S5 had no evidence of on-going training since administrator classes, S3 had no LIC503 (health screening), and S4 and S5 had evidence of TB clearance. In addition, S1 was not associated in Guardian and criminally cleared to work, although had evidence that two attempts to get fingerprinted resulted in poor fingerprint testing with S1 leaving during my inspection to be re-fingerprinted. Licensee was asked to ensure that S1 did not return to work until cleared to work and associated to the facility on Guardian. Three(3) of 3 resident files determined all 3 were missing Consent for Emergency Medical Treatment (LIC627c) and signed Personal Rights (LIC613) Licensee did not have current liability insurance and made a call to his insurance agent and paid for insurance during my inspection and will send in evidence of liability insurance by 08/28/2025. Continued on LIC809C Continued from LIC809C Licensee was given Guardian brochure, as well as, Technical Support Program (TSP) brochure. In addition licensee was given copy of updated RCFE educational requirements for staff members, as well as, records to be maintained at all time for both staff and residents in care and technical violations and advisories were issued. LPA obtained an updated LIC 500 Personnel Report today Licensee to send in evidence of Liability insurance by Thursday 08/28/2025 No deficiencies were cited today. Technical violations and advisories are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure follow CCR and the Health and Safety Code may result in deficiencies and civil penalty assessments during future inspections and/or case management visits. Exit interview conducted with Applicant, whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Aug 22, 2025

The state marks this report as 13 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Prelicensing

At approximately 9:30 AM, Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived announced to conduct a pre-licensing inspection and was greeted by Licensee/Applicant, Omar Chiong. This pre-licensing inspection is being conducted for an initial licensing of an Residential Care Facility for the Elderly (RCFE). Fire Clearance has been approved for 6 non-ambulatory residents. All bedrooms 1,2,3,4,5 are approved for non-ambulatory use. Facility has a dementia care plan. Licensee/Applicant is not currently in partnership with North Bay Regional Center (NBRC) or a placement agency but plans to look into this. At approximately 10:00 AM, LPAs initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed resident showers need shower curtain rods and curtains, Applicant agreed to purchase and install these prior at accepting residents into care. Applicant had non-slip mats and grab bars in place. LPAs observed a supply of clean linens, hygiene products, and paper products available for residents. Hallways are equipped with night lights and residents' bedrooms have all the appropriate furnishings as outlined in Title 22 regulations. LPAs observed dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets as well as under the kitchen sink. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Continued on LIC809-C... ...continued from LIC809... Applicant agrees to keep magnets and keys to these locked areas in facility safe secured and inaccessible to residents in care. Licensee agrees to maintain at least two days of perishable foods and currently has one week of non-perishable foods and an emergency water supply. The required posters were observed hanging in the facility entryway and licensee purchased a long-term care ombudsman poster during today's visit. Licensee was advised to post a copy of their admissions agreement and emergency disaster plan in common area of the facility. Licensee has suggested visiting hours and how arrangements can be made for alternative visiting hours. The facility currently has Applicant and two staff members associated to facility and will hire an additional staff member once license is approved. Applicant has been informed of association and staff transfer process. LPAs observed a sample menu posted in the common area to indicate a healthy and balanced set of meals for residents in care. The facility has a designated computer area for residents in care and Applicant will provide an ipad for residents to use. Facility phone was tested and operational during inspection. Facility has a designated locked closet, as well as locked drawer and cabinet for centrally stored medications and resident, staff, and facility files. LPAs observed first aid kit, PPE, other emergency supplies, activity schedule, and games available for resident use. LPAs recommended that Applicant add additional, age appropriate activities for elderly residents. Facility has a fire extinguisher, which was last inspected 10/2024 and is fully charged. Smoke and Carbon Monoxide detectors were tested and operational during inspection. The backyard features paved walkways and a shaded patio area for resident use. LPAs observed areas where lawn was not level with pavers in the backyard and Applicant agrees to fill these areas in prior to accepting residents in care. LPAs were granted access to backyard shed and observed furniture owned by the home owner from who they have a 5 year lease agreement. Windows, screens, and blinds were all observed in good repair. Applicant will submit proof of liability insurance once home is active, post licensure. LPAs observed a facility sketch which accurately reflects the floor plan. Applicant was not approved for bedridden residents by the local fire department. Continued on LIC809C... Continued on LIC809C... Applicant has since had the fire door installed as instructed by the fire department in order to be approved for a fire clearance which allows for the acceptance of bedridden residents. Applicant will submit a new LIC200 and facility sketch to the Department to request a new fire clearance. Component III orientation was conducted with the Applicant at facility where they conveyed knowledge and understanding of Title 22 regulations. The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. Exit interview conducted with Applicant, whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Mar 27, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Omar Chiong (CEO/Administrator) Interview Method: Virtual interview via Microsoft Teams On March 12, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. 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, Mar 12, 2025