Fruitful Humble Abode

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 01/29/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregivers, Kherjee Reyes and Zenaida Pranada, who were briefly interviewed at this time. This LPA requested that they go ahead and contact the facility designated Administrator, Joyce Mabunga, to inform her that CCL was present at this time. The back up Administrator, Pedro Pancho, arrived shortly thereafter to this facility. Current census was 5 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (2) 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 was (1) resident receiving services through home health at this time. It was learned that this resident also had a bedridden resident in care at this time. The master bedroom was fire cleared to be able to accept and retain up to (1) resident deemed to be bedridden at any given 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. Garage area was toured. Laundry area, located in the room next to the living room, was toured and observed to be locked at this time. A review of the bleach, detergent, and all other cleaning supplies was conducted to make sure that they were locked and made inaccessible to the residents at this time. Administrator certificate, # 7073274740, for Joyce Mabunga was observed to have an expiration date of 07/12/2026 and in compliance at this time. Medication cabinet, located in the facility kitchen drawers, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher located hanging on the wall adjacent to the kitchen was observed to have been annually inspected by the local fire extinguisher company, Touch Down Fire, with the inspection date of 09/11/2025 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 at all times. 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 (5) facility personnel records was conducted and noted on the following LIC 859. A review of (4) 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 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 02/03/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff persons, Kherjee Reyes and Zenaida Pranada, who were briefly interviewed at this time. Current census was 4 residents.. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 01/17/2025. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 01/17/2025: 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. 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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) Plan of Correction clearance letters were printed and copies were provided to the facility designated representatives 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, Feb 3, 2025

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 01/17/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregivers, Kherjee Reyes and Zenaida Pranada, who were briefly interviewed at this time. This LPA requested that they go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. The back up Administrator, Pedro Pancho, arrived shortly thereafter to this facility. Current census was 4 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (2) 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 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 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. Garage area was toured. Laundry area, located in the room next to the living room, was toured and observed to be locked at this time. A review of the bleach, detergent, and all other cleaning supplies was conducted to make sure that they were locked and made inaccessible to the residents at this time. Administrator certificate, # 7073274740, for Joyce Mabunga was observed to have an expiration date of 07/12/2026 and in compliance at this time. Medication cabinet, located in the facility kitchen drawers, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher located hanging on the wall adjacent to the kitchen was observed to have been annually inspected by the local fire extinguisher company, Touch Down Fire, with the inspection date of 09/10/2024 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 at all times. 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 (3) facility personnel records was conducted on the LIC 859. A review of (4) facility resident records 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 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. A civil penalty in the amount of $100 was issued on the following LIC 421 BG at this time. 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 17, 2025

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 01/11/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregivers, Kherjee Reyes and Olivia Camanag. LPA Charlie Yang requested that the facility caregiver go ahead and contact the facility designated Administrator, Joyce Mae Mabunga, to inform her that CCL was present at this time. The facility designated Administrator, Joyce Mae Mabunga, arrived later to this facility while this LPA was conducting this annual visit. A brief interview was conducted with the facility designated Administrator at this time. Current census was (5) residents. This facility does have an approved hospice waiver to accept and retain up to (2) hospice residents at any given time. It was learned that there weren't any residents under the care of hospice at this time. Tour of the facility was conducted. Living area, dining area, and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. Kitchen area was toured. Cabinets and drawers were reviewed. Knives and other sharp objects were observed to be locked and made inaccessible to the residents at this time. Food supply was reviewed to make sure that there was a sufficient amount of 2-day perishable and 7-day nonperishable quantities at all times. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures for handling, dispensing, and documentation of the resident medications was discussed with the facility designated Administrator. Dispensing log was also reviewed along with the Medication Administration Record. A tour of the resident bedrooms was conducted. Furnishings and furniture were observed to be sufficient and maintained in compliance at this time. A tour of the resident restrooms was conducted. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees at all times. Grab bars and non skid mats were observed to be present and in good repair at this time. A tour of laundry room was conducted. It was observed to be locked and made inaccessible to the residents at this time. Laundry detergent, bleach, and other cleaning agents were observed to be present as well. A tour of the garage area was conducted. Additional supplies and items were present for resident use. Linen closet, located in the dining area, was observed to be stocked with adequate towels, comforters, and sheets sufficient to meet the needs of the residents at this time. First aid kit was observed to be present and contained all of the necessary components at this time. Fire extinguishers (2), were located in the entry way and exterior patio area, and were observed to have been annually inspected on 08/16/2023 by the local fire extinguisher company, Armor Fire Extinguisher Company, and in compliance at this time. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gate, and all exits was conducted. It was observed that this facility has an exterior shed in the backyard area. A review of the shed was conducted and observed to be locked and made inaccessible to the residents at this time. A review of (5) facility resident files was conducted on the following LIC 858. A review of (5) facility staff files was conducted on the following LIC 859. 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 weren't any deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 11, 2024

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 01/11/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff persons. This LPA requested that they go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. The facility designated Administrator Joyce Mabunga arrive shortly thereafter to this facility while this LPA was conducting this visit. A brief interview was conducted with the facility designated Administrator at this time. Current census was 5 residents. It was learned that there weren't any residents under the care of hospice at this time. This facility does have a hospice waiver to be able to accept and retain up to (2) hospice residents at any given time. It was learned that there weren't any residents diagnosed with dementia at this time. A tour of this facility was conducted. This Post Licensing visit was conducted in conjunction with the annual visit that was also conducted on this day and time. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 11, 2024