D & L Residential Care Home 1

Type of visit: POC

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced plan of correction (POC) visit to follow up on deficiencies noted on 06/09/26 during an annual visit. LPA Gonzalez met with staff and explained the reason for the visit. The following deficiencies were corrected: Type B CCR 87303(e)(6) Maintenance and Operation. Toilet, hand washing and bathing facilities shall be maintained in operating condition. LPA observed running water to be draining properly in both bathroom sinks, no slow drainage. Type B CCR 87303(e)(5) Maintenance and Operation. Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. LPA observed slip-resistant mats placed on the shower floor in one bathroom and in the bathtub in the second bathroom. Exit interview was conducted and a copy of this report, civil penalties and appeal rights were provided to Caregiver Noel Navarro.the state’s words, verbatim · CDSS document, Jul 2, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual visit. LPA was greeted by staff and the reason for the visit was explained. Administrator Ralph Estanislao was advised telephonically but was not able to attend. The facility is licensed to serve age range 60 and over, six (6) non-ambulatory of which one (1) may be bedridden. Hospice waiver for two (2). The facility is operating within the scope of their license with three (3) non-ambulatory residents. The facility is a single-story home located in a residential area of Glendora. The home consists of a kitchen, living room, dining area, two (2) bathrooms, four (4) resident bedrooms, an attached garage, front and backyards. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. Smoke detectors were observed in the hall and in each resident bedroom. The carbon monoxide detector was not functional as it did not have a battery. Deficiency cited. Four (4) resident rooms were inspected and were observed to contain the required furniture and bedding, all in good repair. Extra, clean linens were observed in a hall closet. continued on LIC809 The door to room #2 had an exterior latching lock, with the potential of locking the resident in their bedroom from outside of the bedroom. Deficiency cited. Staff removed the lock at the time of visit. Flooring in room #3 and room #4 as well as the flooring in the entry, hallway and by the sliding door exit, was observed to be lifting at the seams, which poses a potential tripping hazard. Deficiency cited. Water temperatures in grooming and bathing areas was measured at 103.7°F and 103.2°F, not within the required 105° – 120° F. Technical violation issued. Both bathroom sinks had slow water drainage, to the point that the sink filled during water temperature testing. LPA observed grab bars near toilets and inside showers. LPA did not observe slip-resistant mats, strips or flooring in showers. Deficiency cited. LPA observed sufficient supply of non-perishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. The facility has Emergency Disaster Plan (LIC610E) in place. LPA advised facility to add a temporary shelter location outside of the immediate area. Technical violation issued. Last documented emergency drills were conducted on 03/04/2026. Fire extinguisher is located in the kitchen, last serviced 10/02/25. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. No pools or large bodies of water were observed. Construction of an ADU is almost complete. LPA reviewed three (3) staff files. All files contained the following required documentation: current CPR and First Aid certificates for two (2) of three (3), personnel records, Health screening with TB clearance, fingerprint clearance and job application for three (3) of three (3) personnel records reviewed. LPA reviewed Resident files for three (3) residents. Resident files are maintained at the facility and contain the following required documents: Admission Agreement, Physician's Report (including T.B. clearance and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Medications are centrally stored in a locked kitchen cabinet. Facility keeps a record of centrally stored prescription medications for each resident. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D. Exit interview held and a copy of the report, LIC809D and appeal rights were provided to Caregiver Noel Navarro.the state’s words, verbatim · CDSS document, Jun 9, 2026

The state marks this report as 10 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: POC

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced plan of correction (POC) visit at the facility to follow up on deficiencies noted on 12/29/2025 during an annual visit. LPA met with staff and explained the reason for the visit. LPA spoke with Administrator Ralph Estanislao over the phone. On 12/29/205 LPA Gonzalez conducted an annual visit and noted the following deficiency: Type B section cited 87608(a)(3) Postural Supports (a)Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident ...Postural supports may be used under the following conditions. (3)A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. Based on observation and record review, the licensee did not comply with the section cited above R1, R4 and R5 did not have a order for bed rails. Deficiency was not cleared by POC due date. *Civil penalties were noted for failure to correct.* continued on LIC 809C continued from LIC 809 Type B section cited 87412(a)(11) Personnel Records The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: A health screening as specified in Section 87411, Personnel Requirements - General. Based on record review one (1) out of three (3) staff records, S2 staff file did not contain a completed Health Screening with TB clearance Deficiency was not cleared by POC due date. *Civil penalties were noted for failure to correct.* Type B Section cited 872089(a) Plan of Operation The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49…Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. Based on observation, construction of an additional structure in the backyard has begun without prior notification and approval from licensing, which may affect services to residents. Exit interview was conducted with Noel Navarro and a copy of this report, civil penalties, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced case management visit. LPA was greeted by staff and the reason for the visit was explained. Administrator Ralph Estanislao was advised telephonically but was not able to attend. The purpose of the visit was to follow up on items addressed during the Noncompliance Conference (NCC) meeting held on October 1, 2025. The facility is licensed to serve age range 60 and over, six (6) non-ambulatory of which one (1) may be bedridden. Hospice waiver for two (2). The facility is operating within the scope of their license with five (5) non-ambulatory residents, one (1) of which is under the age of 60 and two (2) residents are on hospice. The facility is a single-story home located in a residential area of Glendora. The home consists of a kitchen, living room, dining area, two (2) bathrooms, four (4) resident bedrooms, an attached garage, front and backyards. Upon arrival LPA observed a port-a-potty in the driveway and visible construction in the backyard. LPA asked administrator about the construction. The administrator indicated the property owner was building an addition. Staff indicated construction workers use a gate located on the side of the house to access the construction area. Construction crew does not come in the house and does not have contact with residents. LPA did not observe any construction tools or construction debris that may pose a health and safety risk to residents in care. Staff stated if residents want to go outside, they go to the front yard. CCL was not notified prior to construction. Deficiency cited. continued on LIC 809C continued from LIC 809 LPA toured facility interior and interior was observed to be clean and free of debris and obstructions. Water temperature was checked in both resident bathrooms and tested at 109.7°F and 109.4°F, which is within the required 105°F-120°F. LPA observed four (4) out five (5) residents to have bedrails. Only one (1) of the four (4) residents had physician’s orders for bedrails in the residents’ files. Deficiency cited. Penalty assessed for repeat violation. LPA reviewed five (5) resident files. Three (3) out of five (5) resident files did not contain record of TB clearance. Deficiency cited. LPA reviewed three (3) staff files. S2 file did not contain a completed Health Screening and did not have TB clearance on file. Deficiency cited. LPA reviewed MAR log. Medications are documented properly and given as prescribed. LPA reviewed log for emergency drills. Last fire/earthquake drill was conducted 12/14/25. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D. Civil penalties issued for repeat violation within 12 months. Exit interview held and a copy of the report along with appeal rights were provided to Caregiver Noel Navarro.the state’s words, verbatim · CDSS document, Dec 29, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(3) · Plan of correction due date: Jan 12, 2026

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above R1, R4 and R5 did not have a order for bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Licensee agrees to send LPA physician's orders for bedrails for R1 and R4 by POC due date or remove bedrails. Orders for R5 were obtained at time of visit

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(c)(1)(A) · Plan of correction due date: Jan 19, 2026

87458 Medical Assessment (c)(1)(A) The medical assessment shall include, but not be limited to: A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: Communicable tuberculosis. This requirement is not met as evidenced by: Based on record review 3 out of 5 resident records did not contain TB clearance which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Licensee agrees to submit via email TB clearance for R1, R2, and R5 by POC due date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a)(11) · Plan of correction due date: Jan 12, 2026

874129(a)(11)Personnel Records The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Based on record review one (1) out of three (3) staff records, S2 staff file did not contain a completed Health Screening with TB clearance which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Licensee agrees to submit via email a completed health screening with TB clearance for S2.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87208(a) · Plan of correction due date: Jan 12, 2026

87208(a)Plan of Operation. The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49…Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement is not met as evidenced by: Based on observation construction of an additional structure in the backyard has begun without prior notification and approval from licensing, which may affect services to residents and which may pose a health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Licensee will submit an updated plan of operation, advise how residents may be affected, a timeline for contruction completion and building permits for construction by POC due date.

Type of visit: Office

A noncompliance conference was conducted with the Licensee, Rafael Diaz for D & L Residential Care Home 1, D & L Residential Care Home 2, and La Posada in Glendora at the Monterey Park Adult and Senior Care Community Care Licensing Office. The purpose of the meeting was to discuss concerns regarding the overall operation of these facilities. The attendees present during the meeting were: Community Care Licensing Regional Manager (RM) Tony Vasallo, Licensing Program Manager (LPM) Adeline Ho, Licensing Program Analyst (LPA) Blanca Gonzalez, and Licensee Rafael Diaz. The licensee currently operates three facilities: D & L Residential Care Home 1 facility # 198602638, D & L Residential Care Home 2 1 facility # 198602639 and La Posada in Glendora 1 facility # 198603124. The attendees discussed the following concerns: • Overdue annual fees • Disproportionate amount of violations • Licensee is not submitting plan of corrections and has submitted incomplete plan of corrections. • Licensee submitted incomplete packets for change of Administrator for D & L Residential Care Home 1, D & L Residential Care Home 2, and La Posada in Glendora • Suspended entities- D & L Medical and L & R Medical are currently suspended. • Background clearance • Civil penalties continued on LIC 809C Licensee understands that Community Care Licensing has placed the facility in a 12 month monitoring compliance plan. Licensee agrees to pay licensing fees and penalties that are due on time Licensee will follow up with LPA Christian Gutierrez to clear citations issued for D & L Residential Care Home 1 annual inspection visit Licensee agrees to comply with reporting requirements and will notify CCL when a bona fide offer is received for La Posada in Glendora Licensee confirmed current addresses on file are correct. Licensee agrees to inform CCL of any changes Licensee agrees to submit completed packets for Administrator changes by 10/02/2025; Board Resolution for D & L Residential Care Home 1 and D & L Residential Care Home 2 and La Posada in Glendora along with a copy of Paula Mera's Driver License Licensee agrees to resolve issue with Secretary of State/ FTB regarding D & L Medical and L & R Medical within 6 to 9 months. Licensee will provide CCL with updates via email every three months. Further details are included in the non-compliance report. The licensee agrees to be placed on a twelve-month monitoring plan with Licensing. Licensee has been advised that failure to complete the above agreed upon actions by the dates and/or continued non-compliance may result in this Department taking additional actions. This case may be referred to CCLDs’ Legal Division. Such referral may result in the filing of an administrative action before the Office of Administrative Law Licensee was provided with copy of Title 22 section 87156, 87205, 87756, 87758,87759, 87761,87766, 87775, and 87777, Exit Interview conducted. A copy of report was given to the licensee, Rafael Diaz.the state’s words, verbatim · CDSS document, Oct 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met caregiver Olga Soto at 10:54 AM and explained reason for visit. Administrator Rafael Diaz was contacted by telephone. The facility is licensed to serve 6 residents 60 years and older. Five (5) can be non-ambulatory and One (1) Bedridden, facility has hospice waiver for two (2). LPA use the CARE tool for this visit. The 1-story facility consist of the following: 4 rooms, attached garage, 1 kitchen, 2 bathrooms, All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. LPA observed bed rails with no physicians’ orders for three (3) residents in care. Smoke detectors/carbon monoxide detectors were observed in each room and throughout facility. The facility has one (1) fire extinguisher that is fully charged in kitchen. Cleaning supplies and toxic substances are inaccessible locked in garage. LPA observed bottles of pills and vitamins in unlocked drawer in kitchen. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grabs bars and non-skid mats. The hot water temperature in the bathrooms were not measured between the required range of 105-120 degrees F. The common areas include the living room and dining area are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in front yard. Passageways and exits are free of obstruction. SEE LIC 809C Two (2) out of two (2) staff files reviewed included Criminal clearance record, and health screening with TB, and both CPR/First Aid certificates were expired. No updated staff training. Administrator file was not available at time of visit. Five (5) resident files were reviewed and were missing updated physicians report, TB clearance, and appraisal needs and service plans, admission agreement. Last fire/earthquake drill was conducted in June of 2024. Infectious control plan was reviewed. One (1) staff and one (1) resident were interviewed. Resident medications were reviewed, and no centrally stored medication log was being used. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection on 7/25/2024. LPA Ramirez was met by House Manager Olga Soto and explained the purpose of the visit. The facility is a single story dwelling that is located on a cul-de-sac. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) resident rooms. Three (3) out of the four (4) resident bedrooms contained required furniture, linens, and lighting. Bedroom#4 is shared and was observed to contain 1 bed and I recliner. Per staff, resident#2 (R2) wishes to sleep in their recliner and not have a traditional bed. Licensee must apply for this exception. LPA Ramirez will issue Type B deficiency based on this observation. LPA Ramirez observed dresser in bedroom#2 to be in disrepair. LPA Ramirez observed dresser in bedroom#3 to be in disrepair. LPA Ramirez will issue Type B deficiency based on this observation. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside showers. LPA Ramirez observed no-slip mat in showers. LPA Ramirez observed a 7in X 12-in tear on living room loveseat that exposed a yellow foam cushion. LPA Ramirez will issue Type B deficiency based on observation. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0 degree F (-17.7 degree C), and refrigerators with maximum temperature of 40 degree F. (4 degree C). SEE 809-C for continuation. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed a facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 06/08/2024 and 03/06/2024. Residents with Special Needs: No large bodies of water were observed. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. LPA Ramirez observed full bed rails on R5 bed. R5 is not on hospice and does not have an exception on file for postural supports. LPA Ramirez will issue Type B deficiency based on this observation. R1’s has a diagnosis which requires a medical assessment annually. During records review, R1’s last documented medical assessment was completed on 4/14/2022. LPA Ramirez will issue Type B deficiency based on records reviewed. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication cabinet, in the facility kitchen area. The facility provides incidental medical services. Staffing: Administrator Certificate for Ralph C Estanislao and it expires on 03/17/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez did not observe required annual training for S1 and S2. CPR and First Aid for four (4) out of the four (4) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for four (4) out of the four (4) personnel records reviewed. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) ambulatory residents, which one (1) may be bedridden. This facility may retain no more than two (2) hospice residents. There are two (2) residents under hospice care. Resident Records/Incident Reports: LPA reviewed Resident files for five (5) residents. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Five (5) deficiencies were observed and cited during inspection. A copy of this report, 809-D and appeals rights was provided.the state’s words, verbatim · CDSS document, Jul 25, 2024