Clarin's Residential Care Home

Type of visit: Required - 1 Year

At approximately 8:50AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required Visit and met with Licensee, Juliana Clarin (Melegrito). Facility is a Residential Care Facility for the Elderly (RCFE) and serves residents with Dementia and has a plan of operation for dementia care and programming on file. Facility is a two story building and has an approved fire clearance for 6 non-ambulatory residents and an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were currently 3 residents in care and 1 staff member on-site. LPA was also informed that there were 2 residents on Hospice. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Licensee. LPA observed the following: Facility is a two story building, where the first floor is designated for residents and the second floor is designated for caregivers/facility staff members only. Facility has a gate at the stairwell to ensure the second floor is inaccessible to residents in care. First floor consists of three (3) resident rooms, two (2) bathrooms, and common spaces. Second floor consists of three (3) staff/caregiver rooms and one (1) bathroom. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Hot water temperatures for a sample size of 3 sinks were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility fire extinguisher was last inspected April 2026. Smoke and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted May 2026. Facility's emergency disaster plan was last reviewed 2025. Facility was observed to have an adequate supply of emergency water accessible in the event they needed to shelter in place for 72 hours. Continued on LIC809C Continued from LIC809 During walkthrough, LPA observed multiple instances of expired food in facility fridge and garage including canned beans, milk, peppers, sausage, and salad kits. LPA and Licensee discussed checking the food storage areas every few days to ensure that food stays safe for consumption. LPA observed an empty container of Comet powder cleaner located under the sink of a resident bathroom. Licensee immediately disposed of expired food and empty Comet container. LPA observed a bottle of Periogard oral rinse located in a resident's bathroom medication cabinet. Licensee immediately made oral rinse solution inaccessible and placed it in facility's locked medication closet. LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized, thorough, and contained required documentation. Staff files had current first aid/CPR certification. Resident files had updated assessments and appraisals. Medication was centrally stored and secure. Administrator's Certificate for Juliana Melegrito (7006827740) was current with an expiration of 01/27/2027. LPA discussed with Licensee on ensuring that resident appraisals/needs and services plans address behavioral expressions if they have been identified in resident medical assessments. LPA also reviewed outstanding deficiencies that were cited in 2023, 2024, and 2025. During visit conducted on 07/21/2023, the following regulations under California Code of Regulations (CCR) and Health and Safety Code (HSC) were cited: CCR Maintenance and Operation 87303(i)(1) - Licensee was to submit a written plan and proof of facility signal system working HSC Other Provisions 1569.618(c)(3) - Licensee was to submit plan on how they would ensure facility staff members have current first aid/CPR certification and submit proof of certification. HSC Other Provisions 1569.625(b)(2) - Licensee was to submit proof of annual training for identified staff member During visit conducted on 07/19/2024, the following regulation under CCR was cited: CCR Maintenance and Operation 87303(e)(3) - Licensee was to submit a written statement and a weekly water temperature log During visit conducted on 05/27/2025, the following regulation under CCR was cited: Criminal Record Clearance 87355(e)(3) - Licensee was to associate identified staff members to facility roster or submit appropriate association paperwork to the Regional Office Continued on LIC809C Continued from LIC809C Review of facility documents and fax confirmations showed that Licensee submitted proof of corrections on the following dates: 2023 visit: CCR Maintenance and Operation 87303(i)(1) - written statement and proof of signal system sent on 08/03/2023. HSC Other Provisions 1569.618(c)(3) - written statement and proof of first aid/CPR for identified staff members sent on 08/07/2023 HSC Other Provisions 1569.625(b)(2) - proof of annual training for identified staff member sent on 08/14/2023. 2024 visit: CCR Maintenance and Operation 87303(e)(3) - proof of weekly water temperature log sent on 08/20/2024. 2025 visit: Criminal Record Clearance 87355(e)(3) - proof of LIC9182/Background Clearance Transfer Request for identified staff members sent on 05/28/2025. All outstanding deficiencies from 2023, 2024, and 2025 have been cleared and plan of corrections letters provided during today's visit. LPA discussed the following with Administrator: Reporting Requirements PIN regarding 911 protocols PIN regarding dementia regulations LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Liability Insurance Active and Current Administrator Certificate Continued on LIC809C Continued from LIC809C Documents to be submitted to Community Care Licensing (CCL) by due date of 07/11/2026. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), LIC9102 (Technical Advisories/Violations), Plan of Corrections, and Appeal Rights discussed and provided to Licensee. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 11, 2026

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 12:35 PM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for three (3), with one (1) Hospice residents currently in care, and is approved for all non-ambulatory residents. Resident (R1) will be moving out at end of month. Administrator Juliana Clarin (Melegrito) arrived approximately 2:15 PM. At approximately 1:15 PM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a two (2) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 9/24. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperatures measured 114.2 and 113.1 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. Facility telephone was tested and operational during inspection. The second story is for caregiver use only and stairs are made inaccessible to residents. Continued 809C... Continued from 809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 5/25. LPA observed facility's infection control plan and emergency disaster plan. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 2:00 PM LPA conducted a review of two (2) resident records. All required documentation present. At approximately 2:20 PM LPA conducted review of two (2) staff records. LPA observed that Staff 1 (S1) and Staff 2 (S2) were not associated to facility (Deficiency cited). At approximately 2:40 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Juliana Melegrito Administrator Certificate 7006827740 expires 1/31/2027. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, May 27, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Araceli Canela arrived at Clarin's Residential Care Home for the purpose of conducting a Required-1 year inspection. LPA met with licensee/Administrator, Juliana Clarin and toured the inside and outside of the home. This facility is licensed for 6 non-ambulatory residents, with approval for 3 of the residents to receive Hospice services and there is no approval for bedridden. LPA toured the home and found the home to be at a comfortable temperature with all exits free from obstruction. This home is a two story home and the second level of the home is used by staff and there is a gate at the bottom of the stairs to make the second level inaccessible to residents. There are a total of 3 bedrooms in the first level of the home that are used by residents. Residents have working auditory devices to use, to call for assistance. Smoke detectors and carbon monoxide detectors were tested and operational. The fire extinguisher located in the kitchen was observed charged and serviced August 9, 2023. There are auditory alerts on exit doors. Water temperature in the resident bathrooms were tested and found to be at 125 degrees F. and Not within appropriate range of 105-120 degrees. LPA requested facility to lower the water temperature. R1 & R2 are both using wheelchairs and staff assist the residents when they are in the bathroom, citation lowered to a type B at this time. Administrator was advised failure to keep the water temperature below 120 will result in the facility being issued a type A citation because of the immediate danger to the health and safety of residents in care. Bathrooms have the required non-skid surfaces and grab bars. Knives are stored in a locked cabinet in the kitchen. There is adequate space and furniture on the patio for outdoor activities. There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. There is a locked cabinet that stores residents' medications, staff and resident files. Continue report see LIC809-C LPA reviewed staff files and staff have proof of current CPR/1st aid that expire 7/28/25 and 4/8/2026. Administrator certificate for Juliana Clarin #6022329740 expires 1/31/2025. Administrator and LPA discussed their Emergency Disaster Plan and Infection Control Plan. LPA went over Reporting Requirements. Licensee/Administrator to submit the current following documents by 8/20/2024: · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents Infection Control Plan of Operation (If changes) Copy of current Liability Insurance The following deficiencies were observed (see LIC 809-D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights providedthe state’s words, verbatim · CDSS document, Jul 19, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.