Dolore Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Robert Campbell conducted an unannounced annual required visit. Upon entry, LPA was greeted by Victoria Baul/House Manager, and informed them of the purpose of the visit. At the time of the visit, there were one (1) staff member and two (2) residents present. Arceli Songco/Administrator, arrived later during the visit. Facility Overview: The facility is a one-story home with six (6) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 118°F. Fire extinguisher located at kitchen had current inspection tag (1/20/2026). Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for four (4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four (4) resident files were reviewed and contained all the required documents. Health-Related Services/Incidental Medical Services: All resident medications were securely locked in Kitchen cabinet. LPA reviewed medications for four (4) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Personal & Incidental Funds: All residents monies are not handled by Facility. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on 12-05-2025, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 27, 2026

Allegation investigated: Facility has a pest infestation (cockroaches).

On 12/01/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation in regards to the allegation noted above. LPA met with Arceli Songco, Administrator where LPA explained the purpose of the visit and the elements of the allegation. The allegation was investigated, and the investigation consisted of observations, interviews and records review. On 11/24/25 Community Care Licensing received a complaint alleging facility has a pest infestation (cockroaches). During today's and shortly after LPAs arrival around 9:28am LPA observed for there to be an unknown pest crawling on the wall inside the den next to the sliding glass door. At 10:10am LPA observed for there to be a live cockroach crawling outside a cabinet above the dishwasher. Additionally inside the kitchen LPA observed for there to be three (3) dead cockroaches, one (1) was a baby, (1) smashed into the tile on the floor, and the other was laying next to the water cooler. LPA conducted an interview with facility staff whom confirmed that the facility does in fact have cockroaches, and that the home was actively being treated by an exterminator Substantiated LPA conducted a records review (email reminder from exterminator company) which revealed that on 11/28/25 the facility was scheduled to be serviced. LPA was provided with a copy of the invoice showing proof confirming that facility was treated. Per an interview with administrator Arceli, the pest control company was coming out on a quarterly basis, until recently (11/28/25), as the problem has been ongoing for about one month concerning to the cockroaches. Per a records review of service notification forms revealed that prior to the 11/28/25 treatment that facility was last treated on 09/19/25, however it was for an unrelated matter. Per Arceli the recent plan with the exterminator included to take the residents out of the facility, and replace all the food, this allowed for the facility to be serviced on 11/28/25. In addition the resident families have been notified. Based on observation, interviews and records review the allegation of facility has a pest infestation (cockroaches) is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where a copy of this report, 9099C, 9099D, appeal rights and LIC9098-proof of corrections form was reviewed and provided to Arceli Songco, Administrator.the state’s words, verbatim · CDSS document, Dec 1, 2025 · control 18-AS-20251124163523

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 15, 2025

87303 (a) 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 requirement is not met as evidenced by: the facility was observed to have live cockroaches crawling around and staff stated the issue had been for about one month, and an appointment was not scheduled until 11/24/25, which posed a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 1, 2025

Plan of correction: The licensee agreed to show proof of follow up visits until the problem is resolved. Proof of POC is to be submitted to the department by 5pm on the due date indicated.

Type of visit: Required - 1 Year

On 02/06/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA was greeted and granted entry by caregivers Leonia and Leonardo Dizon, the Administrator Arceli Songco arrived an hour after LPA arrival, with the resident files, and staff files. LPA discussed the need to have the files at the facility available for review by the department, and that they should be brought at a reasonable time LPA explained the purpose of the visit and verified the facility's contact information that is on file with the department. At the time of the visit there was (3) staff and (5) residents present. LPA was only able to conduct (1) interview as all residents were asleep. The residents are under the weather with symptoms of a cold. The facility is licensed to serve residents age 60 and over with an approved fire clearance for (6) of which (1) may be bedridden and reside in bedroom #1. The facility has an approved hospice waiver for (6) with (3) residents currently receiving hospice services. The facility is a single story home consisting of 5 bedrooms, a caregiver room, and 2 bathrooms, garage, kitchen, garage, backyard with covered patio. The facility was observed to be clean and clutter free. There are no pools or bodies of water on the premises. The resident rooms had the required furnishings such as bed and chest of drawers. The facility food supply was observed to be adequate as there was a (2) day supply of perishable and a (7) day supply of nonperishable food items. All staff were observed to have obtained criminal record clearance and to be associated to the facility. Arceli's Administrator certificate is valid and expires on 08/29/25. The staff were observed to have active Cardio Pulmonary Resuscitation (CPR) training. The governing body is active and in good standing, and the facility annual fees are due by 02/24/25, LPA provided PIN#964477, should the Licensee wish to pay electronically. The medications were observed to be locked and inaccessible to residents in care. The combined smoke and carbon monoxide detectors were tested and observed to be operable. The last emergency disaster drill was conducted on 01/05/25. There are no known guns or ammunition on the property. The facility liability insurance expires 10/16/25. Note: The hot water temperature was unable to be tested/measured due to LPAs thermometer malfunctioning and there was not another thermometer available to use at the facility. Based on today's inspection there were no deficiencies cited, and no citations were issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report was reviewed and provided to Arceli Songco, Administrator.the state’s words, verbatim · CDSS document, Feb 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to conduct an annual visit. LPA was granted access to the home by Victoria Baul, Caregiver. LPA informed Miss Baul the purpose of today’s visit was to inspect the facility to ensure the facility is in compliance with the rules and regulations of California Code of Regulations. LPA conducted a general overall inspection, which included, but was not limited to, the following: physical plant; interior and exterior and records review. Administrator, Araceli Songco arrived shortly after. The facility is licensed for up to (6) residents of which (5) may be Non-ambulatory residents, (1) bedridden and is approved for (6) Hospice waivers. Physical Plant: The one story home consists of (6) resident bedrooms, (2) restrooms, a living room, kitchen and dinning area, caregiver living quarters and backyard area. LPA observed the home was maintained at a comfortable temperature of 71 degrees F. Per Administrator, no ammunition is kept in the home. Resident bedrooms were clean and were observed to have the required furniture, bed linens, proper lighting, drawer/closet space to accommodate each resident. Resident restrooms were checked and observed to be clean; toilets and water faucets worked properly, shower was free of mold/mildew, and Non-skid mats were in place. Common areas were clean and all doorways were clear of obstructions inside the home. The kitchen was checked and observed to be within Title 22 regulations. There was an adequate supply of food for residents in care; a minimum of one week supply of non-perishable and a two day supply of perishable food. Smoke and carbon monoxide detectors were checked, and were in good working order. Fire extinguisher was fully charged. LPA observed all sharps to be locked an secure in a drawer in the kitchen. Drills are conducted quarterly. The last drill was 1/15/2024. LPA measured the water temperature in the resident restroom and found the water, to be within regulatory limits, measuring at approximately 110.3 degrees F. Resident bath towels and toiletries were adequately stocked. Common areas were clean and all doorways were clear of obstructions inside the home. The kitchen was checked and observed to be within Title 22 regulations. LPA toured the backyard; no pool or bodies of water were observed on the premises, the backyard was clean and clutter free. Records Review: A disaster, mass casualty plan as well as the Community Care Licensing Complaint poster were observed to be posted at the facility. LPA reviewed staff/resident records and checked medications. LPA did not observe any excluded persons on premises and all staff on premises had proper finger print clearance. Resident records were current and had proper admission agreements. No prohibited health conditions were observed. All staff records were current and all training was up to date. Based on this inspection, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with the Administrator. A copy this report and the LIC811 was provided to Administrator Araceli Songco.the state’s words, verbatim · CDSS document, Mar 1, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to conduct an annual visit. LPA was granted access to the home by Victoria Baul, Caregiver. LPA informed Miss Baul the purpose of today’s visit was to inspect the facility to ensure the facility is in compliance with the rules and regulations of California Code of Regulations. LPA conducted a general overall inspection, which included, but was not limited to, the following: physical plant; interior and exterior and records review. Administrator, Araceli Songco arrived shortly after. The facility is licensed for up to (6) residents of which (5) may be Non-ambulatory residents, (1) bedridden and is approved for (6) Hospice waivers. Physical Plant: The one story home consists of (6) resident bedrooms, (2) restrooms, a living room, kitchen and dinning area, caregiver living quarters and backyard area. LPA observed the home was maintained at a comfortable temperature of 71 degrees F. Per Administrator, no ammunition is kept in the home. Resident bedrooms were clean and were observed to have the required furniture, bed linens, proper lighting, drawer/closet space to accommodate each resident. Resident restrooms were checked and observed to be clean; toilets and water faucets worked properly, shower was free of mold/mildew, and Non-skid mats were in place. Common areas were clean and all doorways were clear of obstructions inside the home. The kitchen was checked and observed to be within Title 22 regulations. There was an adequate supply of food for residents in care; a minimum of one week supply of non-perishable and a two day supply of perishable food. Smoke and carbon monoxide detectors were checked, and were in good working order. Fire extinguisher was fully charged. LPA observed all sharps to be locked an secure in a cabinet drawer. LPA measured the water temperature in the restrooms and found the water, in the hall, to be within regulatory limits, measuring at approximately 110.3 degrees F. Resident bath towels and toiletries were adequately stocked. Common areas were clean and all doorways were clear of obstructions inside the home. The kitchen was checked and observed to be within Title 22 regulations. LPA toured the backyard; no pool or bodies of water were observed on the premises, the backyard was clean and clutter free. Records Review: A disaster, mass casualty plan as well as the Community Care Licensing Complaint poster were observed to be posted at the facility. LPA reviewed staff/resident records and checked medications. LPA did not observe any excluded persons on premises and all staff on premises had proper finger print clearance. Resident records were current and had proper admission agreements. No prohibited health conditions were observed. All staff records were current and all training was up to date. Drills are conducted regularly. Based on this inspection, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with the Administrator. A copy this report and the LIC811 was provided to the Administrator.the state’s words, verbatim · CDSS document, Mar 1, 2024

Type of visit: Collateral

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced collateral visit to the facility regarding complaint 18-AS-20231002151526. LPA was granted entry and met with house manager Victoria Baul. During the time of the visit, LPA conducted a walk through of the facility, reviewed facility documents and conducted interviews. No health or safety issues were observed during the time of the visit. An exit interview was conducted and a copy of this report was discussed and provided to house manager Victoria Baul.the state’s words, verbatim · CDSS document, Oct 10, 2023