Dolores Homecare

Allegation investigated: Staff speak inappropriately to resident

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to investigate the above allegation. LPA met with Analisa Cayabyab, Administrator and informed them of the purpose of the visit. The Department’s investigation involved interviews with staff and residents and review of records. On April 17, 2026, Community Care Licensing (The Department) received a complaint report with the following allegation. It was alleged that staff speak inappropriately to resident. Information received indicated that Staff #1 (S1) called names and used inappropriate languages to Resident #1 (R1). LPA’s review of R1’s resident file revealed that R1 had cognitive condition and resided here since May 2025. LPA conducted an interview with R1, who stated that S1 used foul languages while S1 was providing care to R1. R1 heard S1 using foul languages a few times in the past several months. Continued on LIC9099-C.... Unsubstantiated R1 stated S1 has not been around for a few months now. R1 stated there were no health and safety concerns. LPA conducted interviews with two (2) other residents, all of whom denied experiencing staff members speaking inappropriately in the facility. LPA conducted an interview with the Administrator who stated that S1 has always followed the residents’ care plans and spoke to residents in professional manner. LPA conducted an interview with S1 who stated that S1 has never spoken inappropriately or heard any staff members speaking inappropriately to residents in care. Based on interviews conducted and file review, the Department’s investigation did not provide enough information to corroborate the allegation that staff speak inappropriately to resident. This allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 23, 2026 · control 18-AS-20260417140210

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mia Lankford, Armando Perez LPA and Toni Nwala LPA conducted an unannounced annual required visit. Upon entry, LPA was greeted by Analisa Cayabyab Administrator and explain the of the purpose of the visit. At the time of the visit, there were three (3) staff members and three (3) residents present. The facility is a one-story home with three (3) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. 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 105°F. Fire extinguisher located at dining area has current inspection date 8/25/2025. Cont-;;LIC 809C 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. Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate.LPA reviewed files forthree (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three (3) resident files were reviewed and contained all required documentation. All resident medications were securely locked. LPA reviewed medications for three (3) residents, confirming that all medications were dispensed per their prescription. LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on January 20, 2026, which met department requirements. All facility exits were clear of obstruction . LPA observed two of two showers needing repair. A deficiency will be cited during the visit. An exit interview was conducted, during which this report, LIC 809D and appeal rights was provided.the state’s words, verbatim · CDSS document, Feb 20, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Nilda Agtang, caregiver, and informed them of the purpose of the visit. At the time of the visit, there were three (3) staff members and three (3) residents present. The facility is a one-story home with three (3) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. 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 120°F. Fire extinguisher located at dining area has current inspection tag. 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. Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Continued on LIC809-C.... LPA reviewed files for four (4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three (3) resident files were reviewed and contained all required documentation. All resident medications were securely locked. LPA reviewed medications for three (3) residents, confirming that all medications were dispensed per their prescription. LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on January 5, 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, Jan 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that four (4) clients live at this facility. There was one (1) staff members present. The Caregiver Anna Kovac conducted the facility tour. The Administrator, Analisa Cayabyab came later to conduct and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Four (4) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Anson Cayabyab’s Administrator’s certificate expiration date is 02/13/2024. The Administrator submitted his renewal 02/09/2024. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 77 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 107 degrees F. Laundry is done in the designated laundry area in the garage. There is a locked cabinet for storing laundry soap and other chemicals in the garage as well as under the kitchen sink, which is locked. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There are zero (0) fireplaces at this facility. There are zero (0) pool at the facility. There are three (3) gates that have a self-latching lock in the front of the facility, the northwest and northeast side of the facility. LPA observed emergency supplies and first aid with the required components. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that all staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed if they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed seven dual (7) smoke detectors and carbon monoxide detectors. There was one (1) fire extinguisher on site on 02/01/2024. Pursuant to the Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to the Administrator, Analisa Cayabyab.the state’s words, verbatim · CDSS document, Feb 15, 2024

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct a case management visit to check on the health, safety, and welfare of residents in care. LPA met with Caregiver, Nilda Agtang who allowed LPA entry. LPA was informed that four (4) residents currently reside at this facility. There were two (2) staff on duty during the time of the visit. LPA toured the facility and observed all facility utilities to be on and operating without issues. The food supply meets the 7-day non-perishables, and 2-day perishables regulatory requirement. There are no immediate concerns for residents in care. No deficiencies are being cited and no civil penalties per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted where a copy of this report was discussed with and provided to Caregiver, Nilda Agtang.the state’s words, verbatim · CDSS document, Nov 20, 2023