Corinthian Garden Residential Care Home

Allegation investigated: -Residents were left without supervision due to staff neglect -Staff do not ensure residents medications are kept centrally secured

On 07/24/2026, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced visit to the facility to initiate a complaint investigation. Upon arrival, LPA met with resident R4 at the door and R4 allowed the LPA to enter the facility. The LPA observed residents R1 and R2 seated in the living room. Resident R1 escorted the LPA to the bedroom located at the end of the hallway, where the licensee, William Encarnacion was present. The LPA informed the licensee of the purpose of the visit. During the visit, the LPA toured the facility, conducted interviews with staff and residents, and reviewed relevant documentation and records. Regarding the allegation that residents were left without supervision due to staff neglect, the Department conducted an investigation that included interviews, observations, and the collection and review of relevant records and documentation. Regarding the allegation that staff do not ensure residents medications are kept centrally secured, the Department conducted an investigation that included interviews, observations, and the collection and review of relevant records and documentation. Substantiated Based on interviews, observations, record review, and other information obtained during the investigation, it was determined that the preponderance of evidence standard has been met, therefore the allegations above are found to be SUBSTANTIATED. The deficiency is cited in accordance with California Code of Regulations, Title 22 Division 6, Chapter 8 and is noted on the attached LIC 9099-D. Report is reviewed with licensee and a copy of the reports and appeal rights are provided.the state’s words, verbatim · CDSS document, Jul 24, 2026 · control 14-AS-20260715141252

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jul 27, 2026

87465 Incidental Medical and Dental Care(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based on information gather during investigation, LPA observed medications were accessible to person other than employees responsible for the supervisions of the centrally stored medication, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 24, 2026

Plan of correction: The facility will develop a written plan to ensure that Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. The facility will submit a copy of the plan to CCL by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 27, 2026

CCR 87464 (f) Basic services...(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code 1569.2(c) "Care and supervision" means the facility assumes responsibility for...the resident’s physical health, mental health, safety Based on interviews, review of facility documentation, staff left the facility premises while responsible for supervising residents, resulting in residents being left without caregiver supervision. creating an immediate risk to resident health and safety.the state’s words, verbatim · CDSS document, Jul 24, 2026

Plan of correction: The facility shall submit a written plan describing how it will ensure staff remain present and provide required care and supervision to residents at all times, including procedures to prevent staff from leaving the facility while responsible for resident supervision. The facility shall submit the written plan to Community Care Licensing by the POC due date.

Type of visit: Case Management - Incident

On 07/24/2026, Licensing Program Analyst(LPA) arrived at the facility to conduct a Case Management Visit in response to an incident report submitted to Licensing in which resident R3 left the facility without staff knowledge. LPA was greeted by licensee and explained the purpose of the visit. LPA toured the facility and reviewed documentation. Based on record review, the facility did not maintain required documentation of a medical assessment for resident R3. A deficiency was cited under California Code of Regulations, Title 22, Division 6, Chapter 8, and documented on the LIC 809-D. Failure to correct deficiencies may result in civil penalties. An exit interview was conducted with the licensee. This report was reviewed with the licensee, and a copy of the report, along with Appeal Rights, was provided to the facility representative.the state’s words, verbatim · CDSS document, Jul 24, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Aug 3, 2026

87458 Medical Assessment(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement is not met as evidenced by: facility did not provide documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.the state’s words, verbatim · CDSS document, Jul 24, 2026

Plan of correction: The facility will develop a written plan to ensure that documentation of a medical assessment to be kept in the resident's record. The facility will submit a copy of the plan and a copy of R3's Medical Assessment to CCL by POC due date.

Type of visit: Case Management - Legal/Non-compliance

On 07/24/2026, Licensing Program Analyst (LPA) Yi Sam Jian arrived unannounced for the purpose of conducting a quarterly probation visit and was greeted by licensee, William Encarnacion. The facility had been placed on probation from April 22, 2025 to April 22, 2028 and is to comply with probation stipulation conditions implemented by the department and was agreed upon with the Licensee. Medications and other toxic products were properly stored in a safe, locked location inaccessible to anyone other than facility staff. Chemicals were locked under kitchen sink and locked in a laundry room cabinet. Monthly training records required by the stipulation have been completed and documented, as implemented by the Administrator. Additional deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8, and documented on the LIC 809-D during case management-incident visit conducted on 07/24/2026 and the 10-day complaint investigation visit conducted on 07/24/2026. An exit interview was conducted. A copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Jul 24, 2026

Type of visit: Office

On 06/19/2026, San Bruno Regional Office conducted an office meeting with Licensee, William Encarnacion. Present in the meeting were Regional Manage Jackie Jin and Licensing Program Analyst Yi Sam Jian. During the office meeting, the Regional Office discussed the facility's contingency plan in the event the licensee becomes unavailable due to a reported upcoming medical procedure. The licensee agreed to submit a written backup plan to Community Care Licensing (CCL) by 06/26/2026. The Regional Office also discussed the document requested by the department auditor regarding a solvency auditing and advised licensee to follow up with the department auditor. This report was reviewed with Licensee, William Encarnacion.the state’s words, verbatim · CDSS document, Jun 19, 2026

Type of visit: Office

On 06/04/2026, San Bruno Regional Office conducted a non-compliance conference meeting with Licensee, William Encarnacion and Administrator, Anna Aoay. Present in the meeting were Regional Manage Jackie Jin, Licensing Program Manager Brenda Chan, and Licensing Program Analyst Yi Sam Jian. During the non-compliance meeting, the following serious violations were discussed: HSC 1569.185(e) The failure of a licensee to pay all applicable and accrued fees; CCR 87463(i) Reappraisal; CCR 87463(h)(1) Reappraisal; HSC 1569.695(c) quarterly drill; CCR 87618(b)(3)(B) No Smoking Oxygen In Use sign; CCR 87303(d) lamps; CCR 87309(a) disinfectant in storage; CCR 87211(a)(1) reporting requirement; HSC 1569.38(e) Posting of licensing reports in a conspicuous location in the facility; CCR 87463(a) Reappraisal; CCR 87213 Finance. During this meeting, the compliance plan was developed and discussed with the licensee which includes more frequent monitoring inspection visits to ensure compliance with this compliance plan and Title 22 Regulations for 2 years. Licensee was provided the link below for resources and guidance to improve facility operations: https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers. This report was reviewed with Licensee, William Encarnacion and Administrator, Anna Aoay. Regional office requested facility to submit updated LIC308 Designation of Facility Responsibility, current control of the property by 06/18/2026.the state’s words, verbatim · CDSS document, Jun 4, 2026

Type of visit: Case Management - Legal/Non-compliance

On 04/28/2026, Licensing Program Analyst (LPA) Yi Sam Jian arrived unannounced for the purpose of conducting a quarterly probation visit and was greeted by licensee, William Encarnacion. The facility had been placed on probation from April 22, 2025 to April 22, 2028 and is to comply with probation stipulation conditions implemented by the department and was agreed upon with the Licensee. Medications and other toxic products were properly stored in a safe, locked location inaccessible to anyone other than facility staff. Chemicals were locked under kitchen sink and locked in a laundry room cabinet. Monthly training records required by the stipulation have been completed and documented, as implemented by the Administrator. No deficiencies cited during today's visit. An exit interview was conducted. A copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Legal/Non-compliance

On 03/04/2026, Licensing Program Analyst (LPA) Yi Sam Jian arrived unannounced for the purpose of conducting a quarterly probation visit and was greeted by licensee, William Encarnacion. The facility had been placed on probation from April 22, 2025 to April 22, 2028 and is to comply with probation stipulation conditions implemented by the department and was agreed upon with the Licensee. Administrator Anna Aoay reported that new staffs are expected to start working by the end of March 2026. Documentation was also observed confirming that residents signed an acknowledgment of the probation stipulation. Medications and other toxic products were properly stored in a safe, locked location inaccessible to anyone other than facility staff. Chemicals were locked under kitchen sink and locked in a laundry room cabinet. See 809D for deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Mar 4, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.185(e) · Plan of correction due date: Mar 5, 2026

HEALTH AND SAFETY CODE The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement is not met, as licensee has failed to pay annual licensing renewal fees Due date 9/22/2025 which poses an immediate health, safety or personal rights risk to clients in care. Licensee was reminded to pay licensing fee during probational visit.the state’s words, verbatim · CDSS document, Mar 4, 2026

Plan of correction: Annual licensing fees and late charges totalling $1237 will be paid BY POC DUE DATE. Proof of payment/correction to be sent to CCLD BY POC DUE DATE.

Type of visit: Case Management - Legal/Non-compliance

On 10/29/2025, Licensing Program Analyst (LPA) Yi Sam Jian arrived unannounced for the purpose of conducting a quarterly probation visit and was greeted by Staff, Maricel Baniaga. Licensee, William Encarnacion, and Administrator, Anna Aoay, were contacted over the phone. The facility had been placed on probation from April 22, 2025 to April 22, 2028 and is to comply with probation stipulation conditions implemented by the department and was agreed upon with the Licensee. Monthly training records required by the stipulation have been completed and documented, as implemented by the Administrator. All staff members on duty were confirmed to be background cleared and associated with the facility. Documentation was also observed confirming that residents signed an acknowledgment of the probation stipulation. Medications and other toxic products were properly stored in a safe, locked location inaccessible to anyone other than facility staff. Chemicals were locked under kitchen sink and locked in a laundry room cabinet. No deficiencies cited during today's visit. An exit interview was conducted. A copy of the report was left at the facility with the facility representative.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: Required - 1 Year

On 9/29/2025, Licensing Program Analyst (LPA) Jian conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by was greeted by Caregiver Staff, Alicia Teope (S1). S1 stated that Licensee, William Encarnacion was at doctor appointment. The facility is a two story home that currently provides care for 5 residents. LPA continued with a tour of the facility with staff, resident’s bedrooms, common areas, kitchen & food storage areas were inspected. All outdoor and indoor passageway were free and clear of obstruction. No accessible bodies of water or fire safety hazards observed. Kitchen was inspected, sufficient supply of food observed. Infection control practices reviewed. Medications, toxins and sharps stored appropriately and inaccessible to clients, a comfortable temperature was maintained, hot water temperature inspected to be compliant, furnishing and lighting was sufficient for comfort and safety. Carbon monoxide detector and smoke detector system inspected and met the requirements. fire extinguisher checked and fully charged. Facility has a written emergency disaster plan. Licensee has at least one completed first aid kit located in the kitchen. LPA observed several deficiencies: one resident bedroom had a malfunctioning light switch that could not be turned off; only one case of 500mL water bottles was available for five clients and staff; resident files lacked documentation of annual visits with a licensed medical professional; one out of five resident files did not include a current reappraisal; only two emergency drills were documented; and there was no sign indicating 'No Smoking – Oxygen in Use' in areas where oxygen equipment is used. Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with licensee and appeal rights provided.This report is reviewed and discussed with the licensee and a copy is provided.the state’s words, verbatim · CDSS document, Sep 29, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Exit doors are obstructed

On 7/23/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of initiating complaint investigation and was greeted by Caregiver Staff, Alicia Teope. Licensee, William Encarnacion was contacted and arrived later in the visit. LPA toured the facility, interviewed staff and outside parties, reviewed resident records, photographed and made observations during the course of the investigation. Complaint alleges exit doors are obstructed. Based upon LPA observations, photos taken and addition photo evidence provided, it was found that the exit door located at the lower portion of the facility was obstructed by several furniture items including chairs and ottomans. In addition, staff (S1) stated that the furniture items were placed at the door to prevent resident (R1) from leaving the facility. Continued onto LIC9099-C Substantiated Based on interviews and observation during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation was determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 23, 2025 · control 14-AS-20250722150938

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Jul 24, 2025

87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement has not been met as evidence by:** Based upon LPA observation and photo taken; several furniture items including chairs and ottomans were observed blocking the fire exit. Interviews with staff (S1) indicated that the items were placed to prevent resident (R1) from eloping. This serves as an immediate health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: Staff immediately removed the items obstructing the passageway/exit. Deficiency cleared at the time of visit.

Type of visit: Case Management - Legal/Non-compliance

On 7/23/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of conducting a quarterly probation visit and was greeted by Caregiver Staff, Alicia Teope. Licensee, William Encarnacion was contacted and arrived later in the visit. The facility had been placed on probation from April 22, 2025 to April 22, 2028 and is to comply with probation stipulation conditions implemented by the department and was agreed upon with the Licensee. Upon a tour of the facility, LPA observed liquid bleach and laundry detergent located in a laundry room cabinet not properly secured and accessible to residents in care. LPA observed a resident in the downstairs portion of the facility in their bedroom, near the laundry storage. Both caregiver staff present were in the upstairs portion of the facility leaving the cleaning chemicals unsupervised. LPA observed the facility postings on the kitchen bulletin, hallway and front door but did not observe documentation of the probationary stipulations visibly posted. LPA spoke with the Licensee who stated that the stipulation document was located in their bedroom and not in a conspicuous location. LPA further discussed with Licensee and staff an incident involving resident (R1) being transferred to a hospital after R1 was witnessed wandering outside of the facility by San Francisco Police. R1 was transferred to medical center for evaluation. Although, review of records indicate R1 was able to leave the facility unassisted, the Licensee failed to ensure that a formal written report was submitted to Licensing within requirements. In addition, Licensee failed to complete a reappraisal for R1 within seven days of the incident after R1 was assessed at the hospital as per probation conditions. Continued onto LIC809-C LPA further discussed the agreed training requirements to be completed for all staff. Upon interview with Licensee and Assistant Administrator, it was explained that a training log and course has been implemented at the Licensee's second facility and has been scheduled for implementation this week. The Department to return at a later date to review the training items. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Jul 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jul 25, 2025

87309 Storage Space and Access (a) The licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended.. This was not met as evidence by:** Based upon LPA observation and photo taken, bleach and laundry detergent found in the laundry room cabinet not properly secured and accessible to residents in care. This serves as an immediate health and safety risk to residents.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: Staff immediately secured the laundry detergent and bleach in the designated storage cabinet. Deficiency cleared at the time of visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Jul 24, 2025

87211 Reporting Requirements (a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events. This was not met as evidence by:** Based upon interviews with Licensee and review of facility records LPA found that an incident occurred involving resident R1 eloping and transferred to the hospital by SFPD. Documentation of the written incident report was not completed or submitted to Licensing within reporting requirements. This serves as a potential personal rights and safety risk to residents.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: Licensee failed to comply with reporting requirements and did not submit a written incident report involving resident R1 to Licensing. Licensee agrees to complete and submit the written incident report to Licensing by POC date 7/26/2025.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.38(e) · Plan of correction due date: Jul 25, 2025

1569.38 Posting of licensing reports; disclosure to new residents (e) ..the notice described in subdivision (b), the licensed residential care facility shall also post a written notice.. in a conspicuous location in the facility.. This was not met as evidence by:** Based upon LPA observation and interview with Licensee, it was found that the documented stipulation of probation was not posted in a conspicuous location in the facility. Licensee stated that the stipulation document was in their bedroom. This serves as a potential personal rights risk to residents.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: Licensee immediately placed the documented stipulation of probation in a conspicuous location of the facility. Deficiency cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Jul 30, 2025

87463 Reappraisals The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition (a) This was not met as evidence by:** Interview with Licensee and outside parties indicate an incident where resident (R1) had been transferred to the hospital for evaluation after being found wandering outside of the facility. A reappraisal for changes of condition or hospitalization was not completed after the incident.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: Licensee agrees to complete a reappraisal assessment for R1 after recent incident and hospital evaluation. Updated reappraisal (LIC625) to be submitted to CCL by POC date 7/30/2025.

Type of visit: Office

On 6/11/25, Licensing Program Analysts (LPAs) Dominic Tobola, Yi Sam Jian and Licensing Program Manager (LPM) April Cowan met with Licensee, William Encarnacion and Administrator, Anna Aoay. During the meeting, LPM, Cowan and LPAs, Jian & Tobola went over and elaborated each item of the Stipulation and Waiver; And Order (“Stipulation”) that was effective on April 22, 2025. During the meeting, LPM elaborated on the stipulation order regarding the facility's license revocation, exclusion and administrator certificate revocation which have been stayed with probation from April 22, 2025 to April 22, 2028 pursuant to the following conditions: A. Respondent must strictly comply with all laws and regulations governing Residential Care Facilities for the Elderly (RCFEs). B. The Department may conduct unannounced inspections during probation to ensure full regulatory compliance. C. All individuals at the facility must have verified criminal clearances or exemptions before their presence and maintain proof on-site. D. Respondents must monitor everyone at the facility to ensure no one is under the influence of illicit drugs. E. Residents must be reappraised within seven days following any unusual incident or hospitalization. F. Staff must receive monthly Title 22 training, with attendance records kept and make-up sessions required within seven days unless otherwise approved. G. Unusual incidents must be reported to Licensing by the next working day with a written report submitted within seven days. Continued in 809-C H. Medications and toxic substances must be safely stored in locked areas accessible only to authorized staff. I. The facility must be maintained in a clean, safe, and sanitary condition at all times. J. All administrators must complete specified training during the probationary period. K. Current and prospective residents and their families must be informed of the probationary license and sign an acknowledgment kept in the resident’s file. L. The Stipulation must be visibly posted at each facility throughout the probationary period. The revocation of Licensee's administrator certificate shall also be stayed with probation from April 22, 2025 to April 22, 2028. Licensee shall be granted a probationary certificate pursuant to the following conditions: A. Respondent may only serve as administrator for Respondent Corinthian and is prohibited from serving as administrator for Respondent Psalm. B. Respondent must complete 40 hours of Department-approved training—25 hours in person—covering RCFE regulation, resident rights and care, behavior observation, facility safety, incident reporting, resident assessments, and medication handling. LPM also went into further detail on the remaining sections of the stipulation including future application for a license registration certification or approval, tolling of probationary period, completion of probation, violation of stipulation term, Department's authority, monitoring fee, waiver of hearing rights, waiver of appeal/modification rights, waiver of claims, public record, signatures, counterparts, effective date, no oral modification, and representations. All meeting participants indicated that they understood the stipulation order. No deficiencies cites during this visit. This report was reviewed with Licensee, William Encarnacion and Administrator, Anna Aoay and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 11, 2025

Allegation investigated: Facility staff are not meeting residents nutritional needs

On 6/5/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of initiating complaint investigation and was greeted by Licensee, William Encarnacion. LPA toured the facility, interviewed resident and made observations during the investigation. Complaint alleges facility staff are not meeting resident (R1) nutritional needs. Upon inspection of facility, LPA observed an ample amount of both perishable and non-perishable food supplies enough for residents in care. Food was observed to be fresh with various options offering nutritional value. Upon statement from Adult Protective Services Worker (I1), the facility was inspected at a previous date and found no concerns or a lack of food supply. I1 had also gathered contradicting statements after interview with R1. LPA conducted interview with R1 during the visit and R1 stated that they did not have any concerns with the food and confirmed that they receive 3 meals per day. R1's statements had contradicted the allegation. LPA observed staff cooking baked chicken for lunch and for residents to take on their outings. A finding that the complaint allegation facility staff are not meeting clients nutritional needs is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiency cited. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 5, 2025 · control 14-AS-20250530125500

Type of visit: Case Management - Incident

On 5/6/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of following up on an incident reported by the facility and was greeted by Administrator, William Encarnacion. The incident occurring on 4/24/2025 involved resident (R1) leaving the facility unassisted. LPA and Administrator discussed the incident and reviewed R1's files. LPA found that based on R1's Physician's Report, R1 is able to leave the facility unassisted. R1's responsible party was notified and R1 was safely located, transferred to medical center for evaluation. R1 had returned back to the facility the same day of the incident with no injuries or changes of condition. Although R1 is able to leave the facility unassisted, Administrator and R1's responsible party are in agreement and have implemented a tracking tag on R1's devices to ensure R1's safety when out in the community. R1 was observed in the living area watching television and in a comfortable position. Administrator has also designated staff to increase checks on R1 when in common spaces to ensure further incidents do not occur. LPA and Administrator also discussed the use of auditory alarms at the primary facility entrance for added preventative measures. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Required - 1 Year

On 9/30/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Licensee, William Encarnacion. The facility is a two story home that currently provides care for 3 residents, all of which were present at the time of visit. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each floor were observed and found to be charged. Both extinguishers were last inspected in 2022. LPA recommended for Licensee to have extinguishers inspected or recharged. Technical Advisory issued. Smoke and carbon monoxide detectors were present and functioning. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished weekly and stored properly. Cleaning supplies and other toxins stored in the kitchen were fond to be secured. Upon inspection of the downstair portion, LPA observed several accessible items that could pose danger to residents in care including: unlocked cleaning supplies and detergent in the laundry room, sharps and other toxins located in the garage without a working doorknob/lock. In addition, LPA observed an unsecured desk drawer in resident common space containing medication containers in need of disposal. Upon observation, LPA found one prescription bottle containing three half pills of narcotics not properly disposed. Licensee immediately removed medications and properly secured cleaning supplies and toxins. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. There is an outdoor patio space for resident use, that is equipped with appropriate shading. During the inspection, residents were observed interacting with staff and one another in the common areas, or in their bedrooms resting. Residents appeared to have a positive relationship with the staff. Continued onto LIC809-C LPA conducted a sample file review for residents and found all three resident needs & service plans in need of updating. Technical Violation issued. In addition, LPA found contradicting information on resident (R1) Physician's Report and requested for Licensee to update. Technical Advisory Issued. Upon a spot check of staff files, LPA found that caregiver staff have current 1st aid and CPR on file. Lastly, A spot check of medications was conducted and found that all medication counts and records are in order. William Encarnacion's Administrator Certificate 7002104740 is currently active through 8/14/2025. LPA requested the following documents be sent to CCL by COB 10/14/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Liability Insurance Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Sep 30, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.