Fruitful Humble Abode I

Allegation investigated: Staff force resident to stay in their room while in care. Staff member handled resident in a rough manner while in care. Staff do not ensure that residents' hygiene needs are met while in care.

On 07/24/26, Licensing Program Analyst (LPA) Melina Oropeza made an unannounced visit to this facility to continue a complaint investigation for the above allegations. LPA identified themselves upon arrival, stated the purpose of their vist to staff. Administrator, Joyce S Mabunga was called and joined 20 minutes later and LPA stated the purpose of the visit. During the visit LPA request and reviewed the follwoing documention: most recent LIC 500, contact information for all facility caregivers, copies of (3) residents Appraisal/Needs and Services Plan, ID/Emergency for (3) residents, LIC 602 for (3) residents, and LIC 604 for (3)residents. LPA interviewed administrator (S1), two staff members (S2) (S3) and two residents (R1) (R2). Staff force resident to stay in their room while in care, based on LPA observations and interviews, residents were observed freely accessing the common areas of the facility. (R1) (R2) stated they are able to leave their rooms whenever they choose. The LPA did not observe anything tied to any resident’s bedroom door or doorknob that would restrict a resident not able to leave their room. Unsubstantiated Staff member handled resident in a rough manner while in care, based on observations and interviews conducted with R1 and R2, S1, S2 and S3, and collateral contacts, no corroborating evidence was obtained to support the allegation. The administrator and staff denied the allegation, residents interviewed did not report being handled roughly, and the LPA observed staff interacting appropriately with residents during today’s visit. Staff do not ensure that residents' hygiene needs are met while in care, based on observations and interviews conducted with R1 R2, S1, S2 and S3, and collateral contacts, residents appeared appropriately groomed, wearing clean clothing, and exhibited good personal hygiene. Resident bedrooms and bedding were observed to be clean and free of offensive odors. R2 stated staff frequently assist with changing and personal care. No evidence was obtained to support the allegation. Based on interviews, record review and observations, the allegations are unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore, the allegations are UNSUBSTANTIATED. Exit interview was conducted and a copy of the report was given the acting administrator, Joyce Smabunga. No citations were issued per Title 22 regulations.the state’s words, verbatim · CDSS document, Jul 24, 2026 · control 27-AS-20260511153812

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 12/04/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Joyce Mae Mabunga, who was briefly interviewed at this time. Current census was 5 residents. It was learned that there were (3) 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 (4) 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 were (3) 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 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 area, located in the room next to the garage, was toured and observed to not be able 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, #7033274740, for Joyce Mabunga was observed to have an expiration date of 07/12/2026 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 hallway closet, 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 extinguishers were located throughout this facility and 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 (6) 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, Dec 4, 2025

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 11/25/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Joyce Mabunga. A brief interview was conducted with the facility designated Administrator at this time. Current census was 6 residents.. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 11/06/2024. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 11/06/2024: 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. Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). The licensee shall retain in the resident's file the original signed and dated admission agreement and all subsequent signed and dated modifications. This does not apply to rate increases which have specific notification requirements as specified in Health and Safety Code section 1569.655. Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. Plan of Correction clearance letters were printed and copies 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, Nov 25, 2024

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 11/06/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Joyce Mae Mabunga, who was briefly interviewed at this time. Current census was 6 residents. It was learned that there were (3) 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 (4) 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 (3) 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. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry area, located in the room next to the garage, was toured and observed to not be able 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, # 6056435740, for Joyce Mabunga was observed to have an expiration date of 07/12/2024 and in compliance at this time. Forms and documents have been completed, notice of paid invoice on 06/24/2024, in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility hallway closet, 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 extinguishers were located throughout this facility and 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 (4) facility personnel records was conducted on the LIC 859. A review of (6) 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. 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, Nov 6, 2024

Type of visit: Post Licensing

Unannounced Post Licensing visit conducted out at this facility by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Joyce Mabunga, at this time. A brief interview was conducted with the facility designated Administrator. Current census was 5 residents. It was learned that there was a resident under the care of hospice at this time. This facility does have a hospice waiver for (4) residents at this time. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Joyce Mabunga. Additional forms and documents were reviewed to make sure that the renewal process was initiated prior to the certificate expiration date of 07/24/2024 with certificate # 6056435740. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe an additional food storage unit which was present and functional at this time in the garage area. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the hallway closet, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility designated Administrator at this time. This medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Garage area was toured. This area housed additional furniture and supplies for the facility residents. Laundry area was toured. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time. Fire extinguisher, located in facility kitchen area, was observed to have been annually reviewed on 08/16/2023 by the local fire extinguisher company, Armor Fire Extinguisher, and in compliance at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gate, and exits was conducted. There were no deficiencies observed or cited during today's Post Licensing visit. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 4, 2023

Type of visit: POC

Unannounced Plan of Correction visit conducted out at this facility by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Joyce Mabunga, at this time. A brief interview was conducted with the facility designated Administrator. Current census was 5 residents. The purpose of this visit was to follow up on the deficiencies and Plan of Correction that was set from a prior annual visit conducted on 11/22/2023. The following Plan of Correction was expected to be completed and submitted into CCL by the due date: 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. Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). All window screens shall be clean and maintained in good repair. A review of the Plan of Correction was conducted. Letters for clearances were printed and a copy was left with the facility designated Administrator at this time. No further deficiencies cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 4, 2023

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 11/22/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Sheram Amparo, who was requested by this LPA to go ahead and contact the facility designated Administrator Joyce Mabunga to inform her that CCL was present at this time to conduct the annual visit. The facility designated Administrator Joyce Mabunga arrived shortly thereafter and was briefly interviewed at this time. Current census was 5 residents. It was learned that there was a resident under the care of hospice at this time. This facility does have a hospice waiver for (4) residents at this time. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Joyce Mabunga. Additional forms and documents were reviewed to make sure that the renewal process was initiated prior to the certificate expiration date of 07/24/2024 with certificate # 6056435740. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe an additional food storage unit which was present and functional at this time in the garage area. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the hallway closet, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility designated Administrator at this time. This medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Garage area was toured. This area housed additional furniture and supplies for the facility residents. Laundry area was toured. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time. Fire extinguisher, located in facility kitchen area, was observed to have been annually reviewed on 08/16/2023 by the local fire extinguisher company, Armor Fire Extinguisher, and in compliance at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gate, and exits was conducted. A review of (5) facility resident records was conducted and noted on the following LIC 858 form. A review of (4) facility staff records was conducted and noted on the following LIC 859 form. The following forms and documents were requested to be updated and submitted into CCL: 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, Nov 22, 2023