Cypress Board and Care

Type of visit: Annual/Random

On August 28, 2026, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit. LPA was greeted by staff and granted entry after stating the purpose of the visit. Licensee/ Administrator Arvin Bumanglag was available to assist with the facility inspection. The facility is licensed for capacity of six (6) residents with approved hospice waiver for six (6) residents. Currently, there is three (3) Hospice residents present during today’s visit. This is a single story with a detached garage facility. The facility has five resident bedrooms and three bathrooms. LPA conducted a tour of the physical plant accompanied by Licensee, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 120.7 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for toxins and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient two day perishable and seven day non-perishable food was maintained. Facility had a supply of emergency food and water. LPA observed one fire extinguisher which was charged and mounted. CONTINUED ON 809C During the visit, LPA observed the facility's screening protocols for visitors, staff, and residents. LPA observed the facility has a supply of Personal Protective Equipment (PPE). LPA observed mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working land line phone was operational. The last disaster drill was conducted on May 26, 2026. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 8/3/2026-8/3/2027. A review of Five residents (R1-R5) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Linh Nguyen - Expiration 1/8/2027 Based on the observations made during today's visit, deficiencies are being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations. An exit interview was conducted with Licensee, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 11, 2026

Maintenance and operation(a) facility should be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidence by observation of sliding door in living room was taped together to seal in door and left back stove burner was non operable. this poses a potential heal & safety risk to residents in carethe state’s words, verbatim · CDSS document, Aug 28, 2026

Plan of correction: Plan of care for Licensee is to repair fixtures and provide proof to LPA by POC due date 9/4/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a)(2) · Plan of correction due date: Aug 31, 2026

Maintenance and operation(a) facility should be clean, safe, sanitary and in good repair at all times...(2)faucets used by residents for personal care shall deliver hot water..to regulate temp of no less than 105 and not more than 120 degrees F.This requirement was not met as evidence by observation of faucet measuring at 120.7 F. This is an immediate Health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Aug 28, 2026

Plan of correction: POC is for licensee to repair water temp to meet regulations. Licensee fixed during visit and water measured at 118.0 within regulations.

Type of visit: Required - 1 Year

On August 12, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) and Licensee Arvin Bumanglag and Linh Nguyen arrived shortly after and was present to assist with the facility inspection on today's date. The facility is licensed for capacity six (6) residents of which two (2) can be non-ambulatory, four (4) ambulatory and one (1) bedridden residents. Facility has approved hospice waiver for six (6) residents. Currently, there are two (2) Hospice residents present during today’s visit. This is a single story with a attached garage facility. The facility has three resident bedrooms, one full bathroom and one half bathroom. At around 8:45AM, LPA Tirre conducted a tour of the physical plant accompanied by Caregiver, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 109.5 to 118.5 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has a fire extinguisher which was mounted and fully charged. CONTINUED ON 809C A review of the Medication Records Administration (MAR) and Centrally stored medication destruction record was conducted for three residents and LPA observed the records are in compliance. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The last fire drill was conducted on June 28, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 8/3/2025 – 8/3/2026. A review of three residents (R1-R3) service files and three staff (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Arvin Bumanglag # 7002119740 - Expiration 12/10/2026. Administrator certification confirmed on CCLD Administration Certification List. During visit Licensee expressed interest in increasing the capacity from 6 to 9 residents. LPA advised Licensee / administrator to submit the following for the capacity increase application. 1. Increase in Capacity Application 2. LIC 200 – Fire clearance 3. New floor plan (sketch) 4. Approved Conditional Use Permit (required above 6 residents) Licensee to submit documents to Regional Office No deficiencies during this inspection visit. An exit interview was conducted with Licensee’s Arvin Bumanaglag and Linh Nguyen, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 12, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Jerome Haley conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Haley met with Applicants Arvin Bumanglang, Linh Nguyen and toured the facility. An initial application to operate a Residential Care Facility Elderly (RCFE) was submitted to CCL on February 9, 2024. The facility has a capacity of 6, of which 2 can be non-ambulatory, and one may be bedridden. The facility phone number 714.723.0008. Fire clearance: Orange County Fire Authority granted the fire clearance March 26, 2024. Structure: The facility is one level structure with 4 bedrooms and 2 bathrooms. Kitchen: Clean and organized. Sharps locked in a cabinet near the sink. Cleaning chemicals are kept locked under the sink. Staff and resident files are kept in a locked cabinet with a first aid kit with all the required elements. Food Service/Menu: A sample menu as posted on the refrigerator. A supply of perishable items, a supply of nonperishable items, and fruits were observed. Stove/Appliances: Gas stove with 5 burners was clean and lighted unassisted. All other appliances were clean and in good working condition. Toxins: All cleaning supplies and chemicals are kept in the kitchen in a locked cabinet below the sink, and an additional supply of cleaning chemicals will be kept locked in a cabinet in the garage. pg 1 of 3 Continued on LIC809C Medications, First-Aid Kit: Resident medications will be locked in a cabinet in the kitchen. A first aid kit is locked in a cabinet in the kitchen where the staff and resident files are kept. Resident/Client & Staff Files: The resident and staff records will be kept locked in the cabinet in the kitchen. Bedrooms: All resident bedrooms had all the required elements (bed, lamb, chair, & storage space) and were in compliance with regulation guidelines. Bathrooms: The resident bathroom has a working toilet, wash basin and shower. Grab bars were tightly secured to the wall. Both bathrooms were clean and organized. There's 1 bathrooms in the facility for residents and a half bathroom in the staff bedroom for staff. Hot Water: Hot water was measured at 117.8 degrees F and 119.8 degrees F. Hygiene Supplies: Additional hygiene items will be stored in the garage in one of the locked storage cabinets. Linens, Hygiene, Emergency Supplies: An emergency food bucket was observed in the garage. Garage: The garage is used as a storage space to store extra items like: adult diapers, hand sanitizers, N95 mask, toilet paper, holiday decorations, and other facility items. There’s a laundry area in the garage with a washer and dryer. There's a few locked storage cabinets in the garage that will be used to store additional items like an additional supply of non-perishable food items, an extra supply of linens, and additional cleaning supplies and cleaning chemicals. pg. 2 of 3 Continued on LIC809C Backyard: Clean and organized. Table with a sunshade and chairs. There’s a locked shed used to store tools, paint, and a lawn mower. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There is fire extinguisher mounted in the kitchen. Component III: Component III was waived. Applicants already operate other licensed facilities. Recommendation/Corrections: Applicants were advised to monitor the hot water temperature. There are no additional corrections to be made. The facility will be recommended for licensure. Exit Interview: Exit interview was conducted, and a copy of this report was provided. pg 3 of 3the state’s words, verbatim · CDSS document, Jul 30, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: INTL Capacity: 6 Census : 0 Method: Telephone call with CAB COMP II Participants: Linh Nguyen & Arvin Bumanglag (Licensees/Administrator) & Tammy Edwards, (Analyst). Licensees/administrator participated in COMP II via Telephone call with CAB Analyst. Identification of licensees/administrator was verified by confirming driver’s license numbers. During COMP II, licensees/administrator confirmed the understanding of Title 22. Component II was successfully completed. Licensees/administrator were advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed licensees/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, Jul 2, 2024