Belford Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Katherine Espina and the purpose of the inspection was discussed. Administrator (AD) Macrina Jabonero arrived at approximately 9:20 a.m. During the inspection, LPA and staff conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with four resident bedrooms, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents listening to music in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested between 116.2- and 119.8- degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked. LPA reviewed five resident files and two staff files. LPA interviewed three residents and two staff. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 20, 2026

Type of visit: Required - 1 Year

On March 5th, 2025 Licensing Program Analyst (LPA) William Vanegas conducted an unannounced inspection for the purposes of an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility, and advised the purpose of the inspection. LPA Vanegas set up equipment and began a tour of the facility and observed the following. This is a one storied home with four bedrooms, three bathrooms one of which is a private bathroom and two that are shared bathrooms. There is an attached two car garage as well. LPA Vanegas observed kitchen area to be clean and free of any mildew, debris, or insects. LPA Vanegas observed a stove, dishwasher, microwave, washer, dryer, and a refrigerator that all appeared to be in good repair, and tested operational. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non-perishable food as well as a sufficient amount of emergency water. LPA Vanegas observed resident bathrooms to be clean and free of debris and mildew. Water faucets and toilets tested to be operational, and bathrooms consisted of all the required furnishings such as grab bars, slip resistant floor matts, and a shower chair. Water tested between 106.5 and 109.2 Degrees. LPA Vanegas observed residents bedrooms to be clean and in good repair. LPA Vanegas observed rooms to have all required furnishings such as a chair, reading lamp, chest drawers, enough storage space for personal belongings, a bed, and clean linens in good repair, meaning no strains or tears. LPA Vanegas observed all required postings to be posted on entry way of the facility. LPA Vanegas observed fire extinguishers to be up to date, and fully charged. LPA Vanegas observed all smoke and carbon monoxide detectors to be in good repair and operational. CONTINUED ON LIC809C LPA Vanegas observed all toxins, sharps, and medications to be locked away and inaccessible to residents in care. LPA Vanegas reviewed medications with Administrator (AD) Edna Tamondong. Per LPA Vanegas review all medications are being documented correctly, and being administered per physicians orders. LPA Vanegas reviewed four employee files and six resident files. All files (Resident and Staff) have all required documents and annual staff training is up to date. LPA Vanegas observed a first aid kit to have all required equipment such as adhesive tape, bandages, scissors, tweezers, and a thermometer. LPA Vanegas observed outside of the facility to be clean and free of any debris or obstructions along the exit routes. All side doors are self latching and unlocked. There is an outdoor shaded sitting area, and the back yard is large enough to accommodate any outdoor activities upon the request of residents in care. Based on observations made today, no deficiencies will be cited per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 5, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Edna Tamondong, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 02/21/2023. This is an initial application with no residents in care. During the inspection, LPA and AP observed the following: Structure: this is a one-story home. Facility is a 4-bedroom, 3-bathroom, 1 story house with an attached garage that is being used for storage. There is a back yard with a patio cover for the residents. Facility telephone number is (714) 646-9071. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lamps, chairs, linens, and storage for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 110 and 112.2 F degrees. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan, and Menu: reviewed. Food Service: 7 days nonperishable food supply reviewed and AP stated they will obtain 2 days perishable food supply prior to accepting residents. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: inspected. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the laundry rom. Medication cabinet is locked. First-Aid Kit and Activity Supplies: observed and available. Resident & Staff Files: this is an initial inspection and LPA observed storage space for resident and staff files. Fire clearance was approved by City of Placentia Fire Department on 11/01/23. Backyard: backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. AP will obtain liability insurance once the application is approved. During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.the state’s words, verbatim · CDSS document, Jan 25, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Macrina Jabonero, Administrator & Edna Tamondong, Licensee Interview Method: Teams Meeting On 12/1/2023, 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, Dec 1, 2023