Blessed Home for Seniors II

Type of visit: Required - 1 Year

On September 3, 2026, Licensing Program Analysts Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPA initially met with staff on duty, Mika Mantupar (S1), and stated the purpose of the visit. The administrator, Aurora Gatchalian (AD), was notified and arrived shortly after. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to six (6) elderly residents, up to 6 may be non-ambulatory, of which, 1 may be bedridden. Bedroom #1 on the facility sketch was cleared for bedridden use. Facility has a hospice waiver for 4 residents. Facility does not have clearance for delayed egress and secured/locked perimeter. Currently, there are no residents who are bedridden nor receiving hospice services. Upon arrival: LPA observed the room temperature to be at 74 degrees Fahrenheit. Present during this visit were five (5) residents in care with two (2) staff on duty. Physical Inspection: Areas that were inspected include, but not limited to, the resident bedrooms, bathrooms, kitchen area, dining room, other common areas and outdoor areas. LPA and staff inspected 6 of 6 resident bedrooms and 3 resident bathrooms. All bedrooms are single occupancy. Each bedroom has their own exit to the outside. Hot water temperature was measured in one of the bathrooms, and it was 109 degrees Fahrenheit. In the kitchen area, LPA observed at least 7-day nonperishable and 2-day perishable food supplies. Knives/sharps and cleaning solutions were locked. Fire extinguishers observed and last serviced on February 23, 2026. Smoke and carbon monoxide detectors were observed throughout. Medication cabinet was observed to be locked and not accessible residents. {1} The outdoor area was inspected, and the fences and gate were observed to be in good repair at this time. No bodies of water were observed. The LPA noted a covered patio area with outdoor furniture available for client use. LPA observed exits #3 and exit #5 on the facility sketch were not installed. Per administrator, it has always been like that since it was licensed. According to CBC, the floor or landing shall not be more than ½ inch lower than the threshold of the doorway. LPA provided technical assistance, informing the facility to install ramp at these exits to ensure safe access to the backyard for non-ambulatory residents. An advisory was provided, reminding the facility to ensure all staff are familiar with the location and operation of utility shut-off valves in case of emergency. Record Reviews: Documents that were reviewed include, but not limited to, resident files, staff files, and other pertinent facility records. Review of 3 of 5 resident file(s) was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. Medications were reviewed for same 3 residents. Advisory was provided to facility to ensure they only assist with medication administration with doctor’s orders and must only follow what is on the prescription order. Review of 3 staff files included but not limited to background clearance, first aid/CPR certification, and training. No compliance issues were noted at this time. Facility conducts quarterly Emergency Drills for fire, earthquake, power outage, and sheltering in place. Last drill was conducted on July 10, 2026. Interviews: 1 staff member was interviewed; 2 residents were interviewed. Documents Requested: LPA requested a copy of updated Liability Insurance, Personnel Records (LIC500), and Designation of Facility Responsibility (LIC308)to be emailed to Department Per the California Code of Regulations, Title 22, Division 6, Chapter 8 and Health and Safety Code no deficiencies were cited. Advisories were provided. Exit interview was conducted with AD. A copy of the report was provided. {2}the state’s words, verbatim · CDSS document, Sep 3, 2026

Type of visit: Required - 1 Year

On 8/6/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their annual inspection visit. LPA met with one of the staff on duty and stated the purpose of the visit. The current administrator Grant Depositar was notified and arrived shortly after. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 non-ambulatory residents, ages 60 and above. Facility has hospice waiver for 4 residents. Facility has 6 resident bedrooms and three bathrooms, and one staff room. Bedroom #2 on the facility sketch was approved for bedridden use. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 5 of 6 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout. LPA measured the hot water temperature in the 1 of 3 bathrooms to be at 117 degrees Fahrenheit. Bathrooms were observed to be in clean. The hallway bathroom sink cabinet was observed to be not locking properly. Advisory was provided to fix the lock. Room temperature was at 76 degrees Fahrenheit.Fire extinguisher was observed and last inspected on 2/6/2025. Smoke and carbon monoxide detectors were observed throughout. In the kitchen area, LPA observed sufficient seven day non-perishable and two day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Insect spray was observed stored in the pantry. LPA observed a Rubitussin medication inside the kitchen refrigerator. Staff immediately placed the medication in a locked area. {Con't to 809-C} {Con't from 809} The garage can be access and unlock from the inside. Garage houses additional refrigerator and freezers. Cleaning solutions and laundry supplies were observed to be accessible to residents. Outdoor area was inspected. LPA observed a covered area for resident use. Ramps were observed to be in good repair at this time. Emergency walkways were observed to be unobstructed. Fence at the garage side of the house was observed to be slightly leaning. Advisory was provided to address this. Record Reviews: Review of 3 of 3 resident files (R1, R2, R3) was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. No issues were noted at this time. Medication review of 2 residents (R1, R2) include review of physician orders for over-the-counter medications. No issues were noted at this time. Review of 3 staff files (S1, S2, S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. LPA also reviewed fire drill/disaster drill records; facility conducts quarterly drill. LPA requested a copy of current Liability Insurance Certificate, LIC500 and LIC308 during this visit. Interviews: LPA interviewed 1 staff and 2 residents in care. Case Management LPA Follow up on death report on 4/28/25. Per review, resident (R4) was on hospice due to medical condition (M1). R4 was on hospice since 4/19/24. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were cited. Exit interview was conducted with S1. A copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Aug 6, 2025

The state marks this report as 9 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Arvin Villanueva conducted a case management visit in order to follow up on Licensing Fees. Presently, the facility has an outstanding balance of $1, 484. 00. LPA initially met with staff on duty, Mika Mantupar, and stated the purpose of this visit. The Administrator Aurora Gatchalian was notified and arrived shortly after. On 7/3/2024, Community Care Licensing Division (CCLD) sent a bill with the annual licensing fees to the Licensee; however, the annual fees have not been paid as of this date. LPA Villanueva informed and explained to Licensee per (CCLD) regulations regarding Licensing Fees - The failure of an applicant or licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. In an effort to assist Licensee with a prompt payment, LPA provided the PIN number, which can be used to pay the balance immediately at CCLD website http://www.ccld.ca.gov/. No citation was issued on this day, however, the following advisory was given: please pay the Annual Licensing Fees to prevent further action. This is not a citation but an advisory. Administrator agreed to pay fees on or by 3/6/2025. An exit interview was conducted. This report was reviewed with Aurora and a copy of this report was left at the facilitythe state’s words, verbatim · CDSS document, Mar 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with facility staff, and explained the purpose of the visit. LPA was later met by Administrator Aurora Gatchalian. LPA Valerio and facility staff Mika toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed 6 residents bedrooms, which were observed to be clean, free from odors, and fully furnished. Resident bathrooms were equipped with skid mats, hand rails, paper towels, toilet paper, hygiene supplies, and a trash can. Hot water was measured within regulatory range. Common areas, such as the kitchen, dinning room, living room, and exterior areas, were observed to be clean and free from debris. No emergency exits were obstructed. The facility was observed to meet food requirements in addition to an emergency supply of food. The facility temperature was observed to be 75 degrees F. Fire extinguisher, carbon monoxide detectors, and door alarm systems were observed to be in working condition. Residents were observed having a family visit, reading a book, watching television, or taking a nap. Staff were observed cooking, cleaning, and assisting with resident ADLs. LPA Valerio reviewed two (2) staff files, which were complete with required annual training. Three (3) residents files were observed to be updated with annual documentation and assessments. LPA Valerio requested the following annual documentation be sent to LPA Valerio: LIC 500, LIC 308, LIC 610D, copy of Liability insurance. Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited today. An exit interview was held, and a copy of the report was provided to Administrator Aurora.the state’s words, verbatim · CDSS document, Sep 10, 2024