Balboa Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility for the purpose of completing the annual required inspection. Upon arrival, LPA was greeted and granted entry by House Manager David Cesena and Jocelinne Aguilar. Brianna Bernal. LPA toured the interior and exterior of the facility and observed the following: This is a one storied home with a total of seven bedrooms one of which is a staff bedroom and three bathrooms, and there is an attached two car garage. LPA and AD tested the smoke detectors and carbon monoxide detectors in the common areas and resident bedrooms, and all were observed to be operational. Residents’ bedrooms contained the required furniture, bed linens, and adequate closet and drawer space to accommodate residents comfortably. LPA observed fire extinguishers mounted in the living room area. Upon review of records, the emergency drill log indicated the most recent drill was conducted on May 01, 2026. LPA observed that sharps and knives were locked in the kitchen and inaccessible to residents in care. Restroom toilets and water faucets were operational. Grab bars were secure, and showers were observed to be free of mold and mildew. The hot water temperature was measured between 105 Degree Fahrenheit. LPA and AD toured the backyard and observed a shaded seating area available for residents’ use. LPA confirmed that emergency exits were free of obstructions. LPA reviewed two (2) resident files and two (2) staff files and observed that the files contained the required documentation. Based on observations and record review conducted during today’s inspection, no deficiencies were cited pursuant to Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) William Vanegas conducted an annual inspection for the purposes of conducting an annual inspection. Upon arrival to the facility LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Humberto Homin. LPA Vanegas set up equipment, and began a tour of the facility This is a one storied home with a total of seven bedrooms one of which is a staff bedroom and three bathrooms, and there is an attached two car garage. LPA Vanegas observed the kitchen area to be clean and free of any debris and mildew. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food along with a sufficient amount of emergency water. LPA Vanegas observed a refrigerator, gas stove, microwave, dishwasher, washer, and dryer. All appeared to be in working condition, and in good repair. LPA Vanegas observed all resident rooms to have the required furnishings such as a bed, clean linens in good repair; meaning no strains or tears, a reading lamp, chest drawers, and enough storage space to store personal items. LPA Vanegas observed all resident restrooms to be clean and free of debris and mildew. Water faucets, and toilets tested to be operational. Water tested between 94.3 and 102.5 degrees. LPA Vanegas observed all fire extinguishers to be fully charged and up to date. LPA Vanegas observed all smoke detectors to be in good repair and tested operational. LPA Vanegas observed first aid kit to have all required items such as adhesive tape, bandages, scissors, tweezers, a thermometer, and a first aid manual. CONTINUED ON LIC809C LPA Vanegas observed the outside of the facility to be clean and free of any debris and free of any obstructions blocking the emergency route exits. LPA Vanegas observed an outdoor shaded sitting area, and side doors to be self latching and unlocked. Backyard is large enough to participate in outdoor activities upon resident request. LPA Vanegas reviewed medications with Care Giver (CG) Humberto Holman. Per LPA Vanegas reivew medications are being documented correctly, and being administered per physicians orders. LPA Vanegas observed all required postings to be posted in the entry way. LPA Vanegas reviewed four resident files, and all files had all required documentation. Base on observations made during today's inspection no deficiencies will be issued per tittle 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with Assistant Administrator Brianna Bernal and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 4, 2025

Type of visit: Prelicensing

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility for the purpose of conducting a pre-licensing inspection. LPA was greeted and granted entry by Mo Jerrar, administrator. An initial application for a license to operate as a Residential Care Facility for the Elderly was received by the Department on September 19, 2023 for a capacity of five non-ambulatory and one bedridden residents. This is a change of ownership with three residents already in care and a potential upcoming admission. LPA accompanied by administrator toured the physical plant. The facility is a one-level home with a frontyard, backyard and attached garage. There are six private bedrooms and one shared bathroom and one guest bathroom. Each of the bedrooms include all necessary components of furnishing including a light, chair, storage space for personal items and a full-size bed as well as a supply of linen and bedsheets. Water temperature was measured to be within acceptable range. Common living spaces are present and a device connected to the internet is present for the use of the residents in care. Facility is clean, sanitary and free of odors in all areas inspected. Required posted documents are observed to be present. Kitchen equipment is present and operating as required. Sharp items and cleaning supplies are confirmed to be secured. A sufficient supply of perishable and non-perishable food is present as required by Title 22 Regulations. The centrally stored medication storage is located in a secure cabinet and a separate cupboard in the bedroom's hallway. The garage is also used for additional storage of food along with emergency and back-up supplies. Staff and client records were reviewed and confirmed to include all necessary components, with the exception of one missing medical assessment for one of the three residents which has been removed from the premises and will be provided to LPA at a later time. CONTINUED ON FORM LIC809-D CONTINUED FROM FORM LIC809 None of the residents currently admitted are receiving hospice care. The fire clearance has been obtained and provided to the Department before the pre-licensing visit. Combined smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional. One fire extinguisher present on the premises is observed to have current maintenance tags. First aid kit verified to be complete. LPA and licensee toured the outside of the facility and observed it to be free of obstructions. One shaded area is present in the back of the house and is equipped with outdoor furniture for the enjoyment of residents and visitors. The perimeter gate present one one side of the house is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Component III was waived as the prospective licensee has already been acting as the current facility administrator and operates other licensed locations as well. This report was reviewed with facility representative and a copy of this report was emailed to the prospective licensee before the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 18, 2024

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: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 Interview Method: Telephone interview On 6/17/2024, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / 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, Jun 17, 2024