Danica's Home

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 01/28/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person, Wilhelmina Torres, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Oliver Flores, to inform him that CCL was present at this time. The facility designated Administrator, Oliver Flores, arrived later to this facility while this LPA was conducting this annual visit. Current census was 2 residents. It was learned that there weren't any residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there was (1) resident diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 7030291740, for Oliver Flores was observed to have an expiration date of 01/18/2027 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility kitchen cabinet , was observed to be locked and made inaccessible to the residents at this time. First aid kit, located hanging on the living room wall, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher, located hanging on the kitchen wall, was observed to have been purchased with an attached receipt showing date of purchase for 01/28/2026 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (2) facility personnel records was conducted and noted on the following LIC 859. A review of (2) facility resident records was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 28, 2026

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 01/28/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Oliver Flores. A brief interview was conducted with the facility designated Administrator at this time. Current census was 2 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior case management visit conducted on 11/19/2025. This visit was to follow up on the Plan of Correction that was due. The following deficiency was observed and cited on 11/19/2025: General facility policies that are for the purpose of making it possible for residents to live together. All facility policies shall be reasonable, and shall not violate any applicable rights, laws or regulations. Plan of Correction clearance letter was printed and a copy was provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 28, 2026

Type of visit: Case Management - Deficiencies

Unannounced case management visit made out to this facility on 11/19/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Wilhelmina Torres, who was briefly interviewed at this time. Current census was 2 residents. This LPA requested that the caregiver go ahead and contact the facility designated Administrator, Oliver Flores, to inform him that CCL was present at this time. It was learned that the facility designated Administrator was out of the facility since he was traveling to the bay area at this time. A phone conversation was held with the facility designated Administrator at this time. The purpose of this case management visit was to follow up on the complaint that was initially filed on 02/04/2025 and completed on 03/05/2025 by LPA Kesha Lewis. There was a deficiency that was cited and a plan of correction that was set with a due date. At the time of this case management visit, the facility designated Administrator has failed to complete the plan of correction and has allowed the due date to lapse without any action at that time. This LPA was present to recite the deficiency and implement a new plan of correction date after discussing this matter with the facility designated Administrator over the phone. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was left with the facility staff person at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 19, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(8)(a) · Plan of correction due date: Jan 1, 2026

General facility policies that are for the purpose of making it possible for residents to live together. All facility policies shall be reasonable, and shall not violate any applicable rights, laws or regulations. This requirement was not met as evidenced by: Based on confirmation that the Licensee has not refunded the prorated amount for the Pre admission fee and the rent payment for November into December 2024 in the amount of $3200.08. This violation poses a potential risk to the health, safety and personal rights of all residents in care.the state’s words, verbatim · CDSS document, Nov 19, 2025

Plan of correction: Licensee shall send a check to the responsible party for R1 in the amount requested by the POC due date. Proof of payment shall be submitted into Community Care Licensing by POC date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced to conduct a case management visit regarding complaint 27-AS-20250204143321. LPA Lewis met with facility administrator FLORES, OLIVER and explained the purpose of the visit. LPA Lewis had Substantiated complaint 27-AS-20250204143321 and the plan of correction was to issue a refund. Mr. Flores reached out to LPA Lewis and asked for an extension because he was going to file an appeal. As of todays date no appeal has been filed and no refund has been issued. LPA Lewis is reissuing the citation on todays date. Citations are issued as indicated on LIC 809D. An exit interview was conducted, Appeal rights provided.the state’s words, verbatim · CDSS document, Apr 29, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(8)(a) · Plan of correction due date: May 5, 2025

Admission Agreements General facility policies...All facility policies...shall not violate any applicable rights, laws or regulations. This requirement is not met as evidenced by: Based on confirmation that the Licensee has not refunded the prorated amout for the pre admission fee and the rent payment for november into decamber in the amount of $3200.08. This violation poses a potential health, and safety risk to residents in carethe state’s words, verbatim · CDSS document, Apr 29, 2025

Plan of correction: Licensee shall send a check to the responsible party for R1 in the amount requested by POC due date. Proof of payment shall be submitted to Community Care Licensing by POC date.

Allegation investigated: Licensee did not issue resident’s authorized representative a timely refund.

Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced todeliver findings for the complaint investigation. LPA Lewis met with facility administrator FLORES, OLIVER and explained the purpose of the visit. Based on records review and interviews with the reporting party and the adminstrator the avove allegation is SUBSTAIATED. During the review of the admissions agreement it was found that an addmendment was added stating that if a resident was on hospice there was not refund to be given. A refund of 3200.08 is due to be refunded within 48 hours. There is a preponderance of evidence to conclude that the allegations noted above are SUBSTANTIATED. Citations are issued as indicated on LIC 9099D. An exit interview was conducted Appeal rights provided Substantiatedthe state’s words, verbatim · CDSS document, Mar 5, 2025 · control 27-AS-20250204143321

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(8)(a) · Plan of correction due date: Apr 3, 2025

Admission Agreements General facility policies...All facility policies...shall not violate any applicable rights, laws or regulations. This requirement is not met as evidenced by: Based on confirmation that the Licensee has not refunded the prorated amout for the pre admission fee and the rent payment for november into decamber in the amount of $3200.08. This violation poses a potential health, and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 5, 2025

Plan of correction: Licensee shall send a check to the responsible party for R1 in the amount requested by POC due date. Proof of payment shall be submitted to Community Care Licensing by POC date via fax. due to facility 99.96- pree admission fee 699.96- rent

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 01/15/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Oliver Flores, who was briefly interviewed at this time. Current census was 1 resident. It was learned that there weren't any residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there was (1) resident diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6065720740, for Oliver Flores was observed to have an expiration date of 01/18/2025 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility kitchen cabinet, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located on the dining area wall, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher that was located in the kitchen area was observed to have been annually purchased from the local hardware store on 01/09/2025 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (2) facility personnel records was conducted on the LIC 859. A review of (1) facility resident record was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 15, 2025

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 08/09/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Oliver Flores. A brief interview was conducted with the facility designated Administrator at this time. Current census was 1 residents. The purpose of this visit was to review and make sure that the following deficiencies that were previously cited on 07/15/2024 were corrected according to the plan of correction: All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. Personnel records shall be maintained for all volunteers and shall contain the following: Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. Facilities shall provide sufficient space to accommodate both indoor and outdoor activities. Activities shall be encouraged by provision of: (2) Outdoor activity areas which are easily accessible to residents and protected from traffic. Gardens or yards shall be sufficient in size, comfortable, and appropriately equipped for outdoor use. The clearance letters were printed and a copy was given to the facility designated Administrator at this time. There were no further deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 9, 2024

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 07/15/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Oliver Flores, who was briefly interviewed at this time. Current census was 1 resident. It was learned that there weren't any residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there weren't any residents diagnosed with dementia at this time. It was learned that there was (1) resident receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility entryway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Laundry area, located in the facility hallway leading into the garage area, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, #6065720740, for Oliver Flores was observed to have an expiration date of 01/18/2025 and in compliance at this time. Medication cabinet, located in the facility kitchen area, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located adjacent to the kitchen area, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher, located in the facility entryway hallway, was observed to have been annually purchased on 09/16/2023 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. This LPA observed additional storage sheds that were present on the east side of this facility at this time. The storage sheds were observed to be locked and made inaccessible to the residents at this time. A review of (2) facility personnel records was conducted and noted on the following LIC 859. A review of (1) facility resident record was conducted and noted on the following LIC 858. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 15, 2024

Type of visit: Prelicensing

Announced Prelicensing visit made out to this facility on 01/03/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Oliver Flores, at this time. A brief interview was conducted with the facility designated Administrator at this time. It was learned that this facility was seeking licensure to accept and retain up to 6 non ambulatory residents at any given time. This facility was seeking licensure with an approved hospice waiver for (6) residents and dementia program. Current census was 0 residents. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator at this time. A review of the facility Medication Administration Record and dispensing log was conducted. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Laundry area was toured. Cleaning supplies, detergents, and bleach were observed to be present and made inaccessible to the residents at this time. Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the garage area was conducted. This area will be locked and made inaccessible to the residents as stated by the facility designated Administrator. First aid kit, located on the wall in the dining area, was observed to be present and contained all of the required components at this time. Fire extinguisher was observed to be placed in the hallway leading into the living area/kitchen area and was just recently purchased on 09/16/2023 and found to be in compliance at this time. A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted. The Administrator Certificate was observed to be posted in the entry hallway for facility designated Administrator, Oliver Flores, with a renewal date of 01/18/2025. The certificate number issued unto this facility designated Administrator was #6065720740. This facility was found to be in compliance at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 3, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Oliver Flores CEO/Administrator Interview Method: Telephone interview On December 5, 2023, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the 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, Dec 5, 2023