Halcyon Place I

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Caregiver Alexsander and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. The facility is a six (6) bedroom, two (2), bathroom home, with a kitchen/dining area, living room, and attached garage. One (1) of the six (6) bedrooms is for the Caregivers. The facility is a Residential Care Facility for Elderly (RCFE) facility Licensed capacity is (6) current census (5). LPA was accompanied by Administrator, Marya Alpert to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 78 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be 113.0 and 118.9 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside medication cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. LPA observed emergency food supply and water for residents and staff in case of an emergency. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Staff personnel files appeared to be maintained and in order. Medications were audited at random. LPA audited three (3) residents files and observed the Administrator did not maintain a updated centrally store medication log. The month of November centrally stored log was missing medications that were prescribed from previous months. LPA observed that 1 out of 3 resident medication was not dispensed according to the doctors order. The bubble pack was stated to have begin on 10/22/2025 and as of today the bubble pack should only have 3 pill in the pack. LPA observed the medication pack had four or more pills remaining in the pack which indicates the medication was not dispensed as prescribed by the doctor and or was missed. There were not any notes explaining the extra pills remaining in the bubble pack. This was observed with four different medications from the centrally stored medication log. Based on the observations made during today’s visit, two (2) deficiencies and one (1) technical violation were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), (LIC809C), (LIC809D) LIC9102TV, and appeal rights was discussed and provided to Mary Grace Matutino, Caregiver.the state’s words, verbatim · CDSS document, Nov 17, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Caregiver Eva Tancinco and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. The facility is a six (6) bedroom, two (2), bathroom home, with a kitchen/dining area, living room, and attached garage. The facility is a Residential Care Facility for Elderly (RCFE) facility Licensed capacity is (6) current census (5). LPA was accompanied by Facility Caregiver, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 72 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be 108.1 and 116.5 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside medication cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed two (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) and (LIC809C) was discussed and provided to Facility Licensee Marya Alpert.the state’s words, verbatim · CDSS document, Nov 25, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Caregiver Eva Tancinco and was granted entry to the facility. At the time of the visit there were two (2) staff present, and four (4) residents present. The facility is a six (6) bedroom, two (2), bathroom home, with a kitchen/dining area, living room, and attached garage. The facility is a Residential Care Facility for Elderly (RCFE) facility Licensed capacity is (6) current census (4). LPA was accompanied by Facility Caregiver, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be 113 degrees F The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside medication cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Caregiver Eva Tancinco.the state’s words, verbatim · CDSS document, Nov 15, 2023

Allegation investigated: Uncleared staff members are allowed to work in the facility. Facility does not have a qualified Administrator.

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Halycon Place I, Residential Care Facility for the Elderly unannounced to initiate a complaint investigation into the allegations listed above. LPA introduced self to staff and stated purpose of the visit. Eva Tancinco, Caregiver granted LPA entry inside the facility and contacted the Administrator, Mayra Alpert to inform her of LPA visit. LPA spoke with Administrator over the phone and disclosed the purpose of the visit. It is alleged that uncleared staff members are allowed to work in the facility. LPA reviewed staff files of seven, (7) staff members employee files. 7 out of 7 employee files included fingerprint and criminal background checks. LPA researched and found that each staff member is also associated to the facility as required by regulation. Additionally, each staff file included up to date training as regulated. It is alleged that the facility does not have a qualified Administrator. A review of staff files revealed that the Please see LIC9099-C Unfounded Based on the information above, these allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies cited at this time. An exit interview was conducted where this report (LIC9099 & LIC9099C) was discussed, and a copy of this report was provided to Facility Representatives at the conclusion of the visit. facility has three active Administrators. Each Administrator Certificate was located inside their staff file and is reflected on the Community Care Licensing Administrator website as up to date and in good standing. There is no evidence to support that facility was at any time without a qualified Administrator. Based on information above, we have found the complaint allegation(s) is/ are unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. A copy of this report is being reviewed with, and furnished to the facility representative.the state’s words, verbatim · CDSS document, Oct 30, 2023 · control 56-AS-20231004142546

Type of visit: Case Management - Other

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Genesis Manor Residential Care for the Elderly to obtain signatures on an Amended Report. LPA met with staff, introduced self and stated purpose of the visit. LPA obtained signatures and completed report. An exit interview was conducted where this report was discussed and provided to facility representative.the state’s words, verbatim · CDSS document, Oct 30, 2023

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility for the purpose of completing a Health & Safety check. LPA met with care providers Victor and Eva Tancinco who were informed of the purpose of the visit. Eva Tancinco (Eva) phoned administrator Marya Alpert and Alpert spoke with LPA on the phone. LPA conducted staff and resident interviews. LPA and staff Eva toured the interior of the home. LPA observed all utilities appear to be operable. Food supply observed to be sufficient for residents in care. During the visit, LPA observed some residents in their room resting while some in facility common areas. LPA observed residents eating in the dining area. No imminent health/safety concerns were observed. Residents in care appeared to be safe with no imminent health/safety concerns. The facility was maintained at a comfortable temperature for the residents in care. The needs of the residents in care appeared to be met during the inspection. An exit interview was conducted and a copy of this report was provided to staff Tancincothe state’s words, verbatim · CDSS document, Oct 23, 2023