Damenik's Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Audrey Jeung toured facility and grounds of this one level home, consisting of five client bedrooms--4 private and one shared--and a staff room with a bunk bed for 2 staff. There are two full bathrooms, a half bathroom (in a private bedroom), dining area, kitchen, and rear office area. The backyard is enclosed and accessible by a ramp from the rear office area. There is a one-car garage, where washer and dryer are located. A comfortable temperature is maintained and lighting is sufficient for comfort and safety. Water temperature is tested in bathroom at 114 degrees F. Medications, sharps, and chemicals are observed locked and inaccessible to residents. Food supplies of perishables for 2 days and non-perishables for 7 days are maintained. First aid kit is observed to be complete. Carbon monoxide detector is tested and operable. There are two staff present with 6 residents. Client and staff records are reviewed. Centrally Stored Medication Records will be reviewed at a later date, due to time constraints. Cynthia Montilla (x5/27), Nicole Montilla (x2/27), Danilo Montilla (x11/26) are a certified RCFE administrators that oversee facility operations. The following information/forms are requested to be submitted to CCLD BY 9/1/26: - Administrative Organization (LIC309) - Personnel Report (LIC500) - Emergency Disaster Plan (LIC610E, including signed and dated page 9) - updated Facility Sketch, showing dimensions and room numbers Proof of current liability insurance is given to LPA today. No deficiencies of the California Code of Regulations, Title 22, are observed. See Technical Advisory Notes --4 pages. Report is reviewed with staff and copies are provided.the state’s words, verbatim · CDSS document, Aug 18, 2026

Type of visit: Required - 1 Year

On 9/9/2025, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Co-Administrator Nicole Montilla. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, garage, and kitchen area and backyard. LPA observed residents in their bedrooms resting. While touring the facility it was observed that the room temperature was at 70 deg F. Hot water was also tested in the bathrooms and the temperature was 112 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed locked. Food supply in kitchen and garage refrigerator was observed with an adequate two day perishable and seven day non-perishable food supply. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill is done every quarter. Six resident records and three staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Sep 9, 2025

Type of visit: Required - 1 Year

On September 09, 2024, Licensing Program Analysts (LPAs) Kiran Jain and Grace Donato, and Licensing Program Manager (LPM) April Cowan arrived at the facility at 12:50 PM to conduct the Annual 1-year required inspection. LPAs and LPM met with Matthew Montilla, Assistant Administrator, and explained the purpose of the visit. LPAs and LPM toured the physical plant and found it to be clean at a comfortable indoor temperature with all exits free from obstruction. This is a single-story building with 5 resident bedrooms, 1 staff bedroom, 2½ bathrooms, a living room, and a kitchen with dining. No accessible bodies of water or hazards were observed. The fire extinguisher was fully charged and last serviced on October 2023. The carbon monoxide detector were observed not working. The attached garage was observed to be clean with a washer and dryer for laundry and extra food supply storage. All rooms were observed to be clean with sufficient furniture and lighting. LPAs observed exit doors equipped with auditory alarms. The bathroom was observed to be mold-free and contained grab bars, liquid soap, and paper towels and a nonskid mat. At 1:10 PM, the hot water temperature in the bathroom sink faucet was measured at 123.8°F. At 2:15 PM, the water temperature was measured at 119.8°F. Sharp objects, detergents, poisons, and soap were observed to be locked and inaccessible to persons in care. No expired food items were observed. The facility had the required 7 days of non-perishables and 2 days of perishables. LPAs reviewed six resident records and three staff records. Emergency drills are conducted quarterly with the last drill documented on June, 2024. The resident’s medications are securely stored in a locked cabinet. Medication administration records (MARs) were reviewed, and no expired medications were observed. The First Aid kit was checked and observed to be sufficiently stocked. LPAs received updated Administrator Certificates for Danilo Montilla and Cynthia Montilla during the visit. The following updated forms are requested to be submitted to CCLD: · LIC 500: Personnel Report · LIC 503: Health Screening Report · Liability Insurance A Type B Violation was provided for Carbon Monoxide detector not working in the facility. The deficiency is cited under the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. An exit interview was conducted. This report was reviewed with Matthew Montilla, Assistant Administrator and a copy of this report along with appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Sep 9, 2024