Care Celine 2

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 Dory Lacwasan. Administrator (AD) Cherry Aguila arrived at approximately 1:40 p.m. and the purpose of the inspection was discussed. During the inspection, LPA and AD 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 four resident beds with full bed rails. One of four resident files did not include a written physician order for the use of full bed rails. LPA also observed one of five residents sitting in their wheelchair with the use of a lap belt and AD was unable to provide LPA with a written order from a physician indicating the need for the postural support; a Deficiency was cited on today’s date. The backyard has a shaded sitting area. LPA observed residents watching television 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 116.9-117.6 degrees Fahrenheit. LPA observed that 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, laundry washer and dryer were all inspected and observed to be operable. Medication cabinet was observed to be locked. (Cont. LIC809-C) LPA reviewed five resident files and one staff files. One of five residents files did not have an update re-appraisal dated in the last twelve months; a Deficiency was cited on today’s date. LPA observed a personnel file for AD/Licensee is not currently being maintained at the facility; a Deficiency was cited on today’s date. Based on the observations made during today’s inspection, 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 and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jun 17, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced Plan of Correction (POC) inspection. LPA was greeted and granted entry by Staff Dory Lacwasan. and the purpose of the inspection was discussed. Administrator (AD) Cherry Aguila was contacted by phone and arrived at approximately 3:00 p.m. LPA is following up regarding deficiencies previously cited on June 20, 2025, during facility's annual/required inspection. Deficiency 1569.625(b)(1) was cited due to one of two staff records not containing documentation consisting of completed 20 hour required staff training. Deficiency 1569.69(a)(2) was cited due to two of two staff files not including documentation of completed 10 hours of initial training, consisting of 6 hours of hands-on shadowing training, and 4 hours of other training or instruction. Deficiency 1569.695(c) was cited due to emergency drills not being conducted. Deficiency 87307(a) was cited due to staff residing at the facility and spending the night on the living room couch. Deficiency 87307(a)(2)(C) was cited due to a bathroom located within a resident's bedroom being used as the staff bathroom. AD provided LPA with completed 20 hours, including six hours specific to dementia care, four hours specific to postural supports, restricted health conditions, and hospice care for staff via email on August 15, 2025. On the same email, AD provided documentation of completed 10 hours of initial training, consisting of 6 hours of hands-on shadowing training, and 4 hours of other training instruction. On July 7, 2025, AD provided LPA with documentation for disaster drill held on July 2, 2025, it included the date, the type of emergency covered by the drill, and the names of staff participating in the drill via email. (Cont. LIC809-C) During today’s visit, LPA observed facility to be at maximum capacity with four of four facility bedrooms currently occupied by residents. In the hallway storage, LPA observed the same dresser and personal items, including clothing and hygiene items previously observed during annual visit on June 20, 2025. Staff Lacwasan confirmed they continue residing at the facility and sleeping on the couch; a Deficiency was cited on today’s date. LPA also observed staff continue to use the master bedroom bathroom located within a resident's bedroom as the staff bathroom; a Deficiency was cited on today’s date. Three of five deficiencies previously cited have been cleared. Based on observations made during today’s inspection, deficiencies are being re-cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Aug 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Sep 12, 2025

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff... This requirement is not met as evidenced by: Based on observation and staff interview, the licensee did not comply with the section cited above as the facility does not have a staff room and staff is residing at the facility and sleeping on the living room couch, which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 15, 2025

Plan of correction: AD stated staff will remove personal belongings and no longer live on-site, spend the night, or sleep on the livng room couch and picture proof provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(a)(2)(C) · Plan of correction due date: Sep 12, 2025

(C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by: Based on observation and staff interview, the licensee did not comply with the section cited above as the master bedroom bathroom located within a resident's bedroom is currently used as the staff bathroom, which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 15, 2025

Plan of correction: AD stated the bathroom located with the residents' bedroom will no longer be used as the staff bathroom. AD stated an in-service will be held to ensure all staff is aware and proof will be provided to LPA via email by POC date.

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 Dory Lacwasan, and LPA explained the purpose of the inspection. Administrator (AD) Cherry Aguila arrived at approximately 2:30 p.m. During the inspection, LPA and Staff Lacwasan 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. In the hallway storage, LPA observed a dresser and personal items, including clothing and hygiene items. Per Staff Lacwasan, the items belong to them as they are currently residing at the facility and sleep on the couch; a Deficiency was cited on today’s date. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 113.7 degrees Fahrenheit. Per Staff Lacwasan, the master bedroom bathroom located within two residents bedroom is currently used as the staff bathroom, a Deficiency was cited on today’s date. 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. Medication cabinet was observed to be locked. (Cont. LIC809-C) LPA reviewed three resident files and two staff files. One of three residents is currently bedridden per their Physician Report (LIC602A). Facility's current fire clearance is for six non-ambulatory residents; a Deficiency was cited on today’s date. Staff files did not contain any documentation for initial staff training; a Deficiency was cited on today’s date. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An immediate $500 Civil Penalty is also being assessed (see LIC421IM). An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jun 20, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with designated Administrator (AD) Cherry Aguila. An application to operate an Residential Care Facility for the elderly (RCFE) for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden residents was received by CCL on November 1, 2023. Structure: The facility is a one-story house with four bedrooms, two full size bathrooms, one half bathroom, one living room, one kitchen, one dining area, one laundry room, and attached two car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entranceway. There is a backyard with an exit gate each side of the house and LPA did not observe any obstacles or hazards. Resident Bedrooms All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. Signal system There is no signal system. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and locked underneath the kitchen sink. Medications, First-Aid Kit & Book: Medication will be stored in a locked closet. First aid kit is stored in a kitchen cabinet. The first aid kit has all the required elements. Resident & Staff Files: Records will be kept in a locked closet. Pool/Jacuzzi: No bodies of water were observed. Fire Extinguisher: Fire extinguisher is fully charged with service tag dated June 3, 2024. Reading Material, Games, Equipment & Materials: The facility has activity books, arts and crafts supplies, board games, and other recreational materials for resident use stored in the living room. Fire clearance: Was approved by a fire inspector of the City of Placentia Fire Department on November 14, 2023. Special conditions noted, “Bedrooms 3 shall be used for ambulatory clients only.” Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. Bedrooms Staff: There is no staff bedroom. Bathrooms: All bathrooms have working plumbing. Hot water measured between 117.1- and 118.2- degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen was stored in the hallway storage. Emergency Phone Numbers, Exit Plan & Menu: Posted and available, means of exiting, and emergency phone numbers. Food menu will be posted and available. Food Service: A supply of 2-day perishable and 7-day of non-perishable food was observed and will be maintained on hand. Smoke Detectors: Smoke detectors and carbon monoxide detectors tested operational. Appliances: Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jun 20, 2024