D & L Residential Care Home 2

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. 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 four (4) non-ambulatory residents, one (1) of which is bedridden. The facility is a single-story home located in a residential area of Glendora. The home consists of a kitchen, living room, dining area, three (3) bathrooms, six (6) resident bedrooms, front and backyards. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for today’s visit and observed the following: LPA toured facility interior and exterior and observed passageways and exits to be free of debris and obstructions. Room temperature was kept comfortable. Water temperature was tested in resident bathrooms and measured at 109.5°F in (2) bathrooms, which is within the required 105°F- 120°F. LPA observed grab bars near toilets and inside showers. Shower floor in hall bath was observed to have mold around the shower floor mat and rust around the shower chair. Deficiencies cited. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. Carbon monoxide/Smoke detectors are located in the hallway, were tested and are operable. continued on LIC809C LPA observed sufficient supply of nonperishable for one week and perishable foods for a minimum of two days in the kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. All kitchen areas are kept clean and free of litter, rodents, vermin and insects. Residents’ bedrooms were observed to have required furniture. Two (2) residents had bed rails. LPA observed physician's orders for bed rails in place. Linens were clean and in good repair. Extra, clean linens were observed in a hall closet. LPA reviewed four (4) resident files. R4 facility file did not have TB clearance available for review. Deficiency cited. The medications are centrally stored in a locked kitchen cabinet. LPA reviewed MAR log. Medications are documented properly and given as prescribed. LPA reviewed three (3) staff files. Files contained required documents, training, and all staff are cleared and associated to the facility. The facility has the Emergency Disaster Plan (LIC610) but was not the correct form for the facility type. Technical Violation issued. LPA reviewed log for quarterly emergency drills. Last drill conducted 01/19/2026. No pools or large bodies of water were observed. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. 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 along with appeal rights were provided to Caregiver MarkJohn Salonga.the state’s words, verbatim · CDSS document, May 18, 2026

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.

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 four (4) non-ambulatory residents, one (1) of which is bedridden and one (1) resident 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, three (3) bathrooms, six (6) resident bedrooms, front and backyards. LPA toured facility interior and exterior and were observed to be clean and free of debris and obstructions. Room temperature was kept comfortable. Water temperature was tested in resident bathrooms and measured at 106.5°F in (2) bathrooms, which is within the required 105°F- 120°F. The third bathroom tested at 100.5°F, which is not within the required 105°F- 120°F. Technical violation issued continued on LIC 809C continued from LIC 809 Residents bedrooms were observed to have required furniture. Three residents had bedrails. LPA observed physician's orders for bedrails in place. LPA reviewed four (4) resident files and were observed to contain the required documents. LPA reviewed MAR log. Medications are documented properly and given as prescribed. LPA reviewed three (3) staff files. Files contained required documents, training, and all staff are cleared and associated to the facility. LPA reviewed log for emergency drills. No current emergency drills have been logged, last drill logged 12/2023. Deficiency cited. 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 along with appeal rights were provided to Caregiver MarkJohn Salonga.the state’s words, verbatim · CDSS document, Dec 29, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(c) · Plan of correction due date: Jan 19, 2026

(c) A facility shall conduct a drill at least quarterly for each shift...Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Based on record review, there are no current logs for emergency drills conducted, last emergency drill logged was 12/2023, which poses a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Licensee will submit via email Documentation of the drill which shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, 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) Vaid conducted the annual inspection using the Compliance and Regulatory Enforcement tools. LPA met with caregiver Rebecca Huilar, Administrator Rita Herrera was not available due to sickness, and explained the reason for the visit. The facility has a capacity of six (6) residents. It is licensed to serve elderly residents aged 60 and above, approved for six (6) non-ambulatory, of which one (1) may be bedridden. Facility approved for two (2) hospice waivers. The facility cares for elderly residents with dementia. Currently, facility has three residents with dementia. The facility is in a residential neighborhood, a single-story home and consisted of six (6) resident’s bedrooms, four (4) bathrooms, living room, staff room, kitchen, dining room, outdoor laundry, back house for live in staff. LPA conducted a tour of the facility, reviewed records, and interviewed 1 staff. The following were observed: Currently the facility has three residents. Three (3) out of six (6) occupied bedrooms have the required furniture such as bedframes, dressers, lamps, and chairs. Beds have the required linen, and the linen is in good condition. There are three (3) bathrooms for residents’ use. Bathroom #1-#3 have the required grab bars in the shower and near the toilet and nonskid mat. The hot water temperature was 107.3-109.4 and 106.3 degrees respectively, which is within the required 105 - 120 degrees. Continued on 809C.............. The facility temperature at the time the visit was comfortable 79.1 deg F. There are smoke detectors located throughout the facility. There is a carbon monoxide detector in the hallway. 1 fire extinguisher in the kitchen, last inspected 4/24/25. The kitchen appliances are properly working. There was a sufficient supply of 2 days perishable food, and 7 days non-perishable foods were observed. The front and backyard are well maintained. There is no pool or other large bodies of water. The facility has the required auditory devices on exit doors for dementia residents. The auditory devices were observed to be working at the time of the visit. There are no cameras in the facility. Four (4) staff files and have the required documents. One (1) staff was interviewed. Three (3) residents files were reviewed and one (1) out of three (3) were missing required documents. Three (3) out of three (3) residents’ medications were reviewed. Medications are centrally stored and locked MAR log is used. Fire drill is missing. Infection control plan is missing. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 25, 2025

Allegation investigated: Staff did not intervene between residents during an altercation.

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced 10 day complaint visit and met with Bobby Allardo and discussed the purpose for todays visit. Shortly afterwards Administrator Rita Herrera arrived and joined the visit. Investigation consisted of the following: LPA Wesley request to see Resident 1 and Resident 2 file, the staff and resident roster. Interviewed resident 1, 2, the administrator, and staff #1, staff #2 Investigation Revealed the folllowing: LPA Wesley interviewed resident #1 and she said she was about to leave date and time unknown, and resident #2 approached her and put his hands on her walker and asked her not to leave. She said the resident held her hands to her walker for about 1 hour and then he let her go when he realized she was not leaving. Staff #1 did not witness the incident because he was not in the front of the facility and said he asked staff #2 about it and he didn't say anything about them having an altecation. Staff #2 did not Continued on LIC 9099C Unsubstantiated return the next day. The Police came to the facility on 03/14/25 at 1704 to 1732 and conducted an investigation, and didn't feel like any harm was done, or that there was a threat, so they left the facility without making a report. Resident #1 told LPA Wesley that she is not threatened by the resident and don't plan to press any charges. LPA Wesley observed resident 2 and resident 1 around the same location and everything was running smooth. The Administrator believes it happened on 02/23/25. LPA Wesley observed Resident #1 interacting with Resident #2 and she didn't appear to be in any emotional distress. Based on the interviews conducted with staff, residents, review of residents medical files and facility records, there was not enough supportive evidence to concur with the reported allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation(s) are UNSUBSTANTIATED. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 11, 2025 · control 28-AS-20250304103541

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Nicol Wesley conducted a Case Management inspection as a result of the complaint visit 28-AS-20250304103541 conducted 03/11/2025. During the complaint visit, LPA Wesley observed space heaters in the living room and kitchen area, and asked if the heater works. LPA Wesley was told no. LPA also observed trash cans with no lids and during the complaint investigation there was no clearance for staff #1. The following deficiencies are cited according to the California, code of regulations, title 22. appeal rights given. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Mar 11, 2025

Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or... This evidence was not met as required..during the meeting with the residents and administrator it appears that staff Bong Narcisco Jr. was not cleared/associated to the facility and posed a health and safety threat to the residents in care.the state’s words, verbatim · CDSS document, Mar 11, 2025

Plan of correction: The facility shall make sure all staff all staff are fingerprint cleared and associated prior to working in a facility. Per the administrator Rita Herrera, staff Bong Narcisco Jr. is no longer working in the facilty. **Immediated $100 civll Penalty issued**

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Apr 10, 2025

Maintenance and Operations The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This item was not met as required: When LPA arrived to the facility she observced space heaters in the living room dinning room of the faclity which poses a health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Mar 11, 2025

Plan of correction: The Administrator shall have the centralized heater repaired and send proof of service to Attn Nicol Wesley, 323 980 4912 by POC due date 04/10/2025

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 with Administrator Rafael Estanislao at approximately 11:08 AM and explained the reason for the visit. The facility has a capacity of six (6) residents. It is licensed to serve elderly residents aged 60 and above, approved for six (6) non-ambulatories, of which one (1) may be bedridden. Facility approved for two (2) hospice waivers. The facility cares for elderly residents with dementia. Currently, facility has three residents with dementia. Annual fees are not current. Administrator has been advised and pin number provided. The facility is located in a residential neighborhood, a single-story home and consisted of six (6) resident’s bedrooms, two (2) bathrooms, living room, staff room, kitchen, dining room, outdoor laundry, back house for live in staff. LPA Gutierrez conducted a tour of the facility, reviewed records, and interviewed 2 staff. The following were observed: Four (4) out of six (6) Bedrooms have the required furniture such as bedframes, dressers, lamps, and chairs. Bedrooms #1 and # 4 are missing chairs. Beds have the required linen, and the linen is in good condition. There are 2 bathrooms. Bathroom #1 have the required grab bars in the shower and near the toilet and is missing nonskid mat. Bathroom #2 grab bar in shower is broken non-skid surface/mats in place. Bathrooms# 2 was observed to have cleaning supplies unlocked in cabinet and accessible to residents. The hot water temperature was 107.3-109.4 degrees during the visit, which is within the required 105 - 120 degrees. The facility temperature at the time the visit was comfortable There is sufficient lighting throughout the facility There are smoke detectors located throughout the facility. There is a carbon monoxide detector in the hallway. The kitchen was inspected. There was a sufficient supply of 2 days perishable food, and Seven (7) days non-perishable foods were observed. The front and backyard are well maintained. LPA observed cleaning solutions on patio floor accessible to residents There is no pool or other large bodies of water. The facility is required to have auditory devices on exit doors for dementia residents. The auditory devices were observed to not be working in two (2) out of six (6) resident rooms at the time of the visit. There are no cameras in the facility. Four (4) staff files were reviewed and missing required documents. Five (5) residents files were reviewed and five (5) out of five (5) were missing required documents. Last fire/earthquake drill was conducted in April of 2023. Infectious control plan was missing. Two (2) staff were interviewed. Six (6) out of (6) residents’ medications were reviewed. Medications are centrally stored and locked MAR log is used. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 18, 2024