Home at Cascade Lane

Allegation investigated: Facility is not allowing visitors Facility phone is non operational Facility does not retain resident records Facility is not allowing resident to attend church Facility staff took residents property

On July 15, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for a subsequent complaint investigation visit into the above allegations. LPA was greeted and granted entry after stating the purpose of the visit to staff. Administrator Jeannie Dao was contacted and arrived shortly to assist with the visit. During the course of the investigation, LPA reviewed facility documents including: Resident Roster, Staff Roster, Physician’s Reports, and Needs and Service Plans. Interviews were conducted with residents and staff. Regarding the allegation, Facility is not allowing visitors, it is alleged that the facility is not permitting visitation for residents. Five out of six residents interviewed denied the allegation. Resident 5 (R5) and Resident 6 (R6) stated their visitors have never been turned away and they always adhere to the visiting hours. LPA observed Visiting Hours of 9am-7pm Daily, posted in the entry way. REPORT CONTINUES ON LIC9099-C…. Unsubstantiated Three out of three staff denied the allegation, stating residents are always allowed to have visitors during visiting hours. Per Administrator, there are no restrictions on visitations unless they are before or after visiting hours. There is no evidence to support the allegation that staff are not allowing visitors. Regarding the allegation, Facility phone is non operational, it is alleged that facility telephone is not in working order. Based on observation, LPA observed a working telephone in the kitchen area. LPA Bentley tested the facility phone at (714) 373-1218 and it was deemed operational. Three out of three staff denied the allegation stating the facility phone is available to residents in care. Six out of six residents denied the allegation stating they are permitted to use the facility phone for incoming and outgoing calls when needed. Two out of six residents have their own cell phone. Regarding the allegation, Facility does not retain resident records, it is alleged that the facility is not retaining resident records. Three out of three staff interviewed denied the allegation. During the investigation, LPA observed resident records securely stored in the closet with medication. A record review revealed the facility retained records for all six residents in care, including Physician’s reports, Doctor’s orders, Needs and Service Plans, Consent forms, Medication records, and Admission Agreements. Regarding the allegation, Facility is not allowing resident to attend church, it is alleged that the facility is restricting R1 from attending church services. Three out of three staff interviewed denied the allegation, stating the resident have not made any requests to attend church. During the interview, R1 stated they are not interested in attending church services and staff has not restricted them from attending. Regarding the allegation, Facility staff took residents property, it is alleged that facility staff removed an APS business card from R1’s room. Three out of three staff interviewed denied the allegation, stating they did not remove the business card and was not aware that R1 had it in their possession. There is no evidence to support the allegation that staff removed the APS business card from R1’s bedroom. Based on the observations made, interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the aforementioned allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Jeannie Dao and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 15, 2026 · control 22-AS-20260420170844

Type of visit: Required - 1 Year

On July 15, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purposes of conducting a required 1-Year annual visit using the CARE Inspection Tool. LPA Bentley was greeted and granted entry into the facility by staff, after stating the reason for the visit. Administrator (AD) Jeannie Dao arrived shortly to assist with the visit. The facility is licensed to operate age 60 and over for (6) non-ambulatory only residents of which one (1) may be bedridden in Bedroom 2 only, with a Hospice waiver for six (6). The building is a single story structure located in a residential neighborhood, which consists of the following: six (6) resident bedrooms, three (3) staff bedrooms, two and one-half (21/2) bathrooms, living area, dining area, kitchen, an outdoor covered seating area, and an attached two car garage. Currently, the facility is at capacity with a census of six (6) residents in care. LPA Bentley toured the inside and outside of the physical plant with AD Dao. All rooms were inspected and the facility was observed to be appropriately furnished at the time of visit. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Additional linens, comforters, and bath towels were adequately stocked and available. Bathrooms were found to be clean and operational with water temperatures measured at 117.6 degrees F. The kitchen was observed clean, all appliances were operational, and there was a two-day supply of perishable and seven-day supply of non-perishable food available. Toxins, disinfectants, sharps, and medications were secured. The backyard was observed with a shaded seating area for residents and the facility has one exit gate that was operational. REPORT CONTINUES ON LIC809-C...... The smoke alarms and carbon monoxide detectors were operable. An emergency safety drill was last conducted on April 1, 2026 and are conducted quarterly. Emergency food, emergency water, and emergency supplies were stored in the garage. The facility has two (2) fire extinguishers that were charged, mounted, and last serviced on February 23, 2026. First aid kit is maintained and contains all the necessary elements. A working telephone (714-373-1218) remains available and there is a device that can be used by residents for teleconference purposes. Liability Insurance is effective November 25, 2025 and expires on November 25, 2026. LPA Bentley conducted an audit of six (6) resident files (R1-R6), three (3) staff files (S1-S3), and medication and medication administration records review. Interviews were conducted with staff and residents. Based on today’s observations, no deficiencies are being cited during the visit, per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrator Jeannie Dao, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 15, 2026

Allegation investigated: Facility was refusing to have visitors.

Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to deliver the findings on the above allegation. LPA met with staff on duty and explained the reason for the visit. Staff notified Administrator (AD) Jeannie Dao via telephone. During the course of the investigation, LPA inspected the facility, interviewed staff and residents, obtained and reviewed resident records. The investigation revealed the following: It was alleged that the facility was refusing residents to have visitors. Four out of five witnesses confirmed that the visitor was disruptive when visiting the facility. The Department received two incident reports dated December 24, 2025, that on December 22 and 23, 2025, visitors went to the facility screaming, yelling, drunk, disrupting residents, bullying and arguing with the caregiver. One out of five witnesses reported that RP damaged the printer at the facility. On December 24, 2025, visitor attempted to enter the facility. Continued on LIC 9099-C. Unsubstantiated Staff called the Huntington Beach police for assistance, and the visitor was sent home by the Huntington Beach PD. During the investigation LPA confirmed that the facility allows all residents to have visitors. Based on interviews conducted with four out of four staff, it was revealed that administrator filed a restraining order against the visitor on January 27, 2026. Per records obtained the restraining order for civil harassment is scheduled for a hearing on February 19, 2026. Based on the evidence gathered during this investigation, 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, therefore the allegation is Unsubstantiated. An exit interview was conducted with Administrator, Jeannie Dao, and a copy of the report was reviewed and provided during the visit. LPA obtained correspondence that revealed the resident’s sole property has been sold in a foreclosure sale on August 7, 2025, and the sale of the property was recorded that there were no proceeds from the sale as more was owed than obtained from the foreclosure sale therefore there is no financial abuse. Based on the evidence gathered during this investigation, the allegation is deemed Unfounded, meaning the allegations are false, could not have happened and/or are without a reasonable basis. An exit interview was conducted with Administrator, Jeannie Dao, and a copy of the report was reviewed and provided during the visit.the state’s words, verbatim · CDSS document, Mar 13, 2026 · control 22-AS-20251230151122

Allegation investigated: Facility staff are ignoring call buttons.

On today's date January 28, 2026 Licensing Program Analysts (LPA's) William Vanegas and Brandon Lopez made an unannounced visit to the facility to initiate the investigation to the above listed allegation and to deliver the complaint findings. LPA's were greeted and granted entry to the facility by facility staff, LPA's explained the purpose of the visit, LPA's conducted a tour of the facility and observed residents in care lounging in respective common areas and their bedrooms. LPA's conducted resident and staff interviews. Additionally LPA's collected and conducted record review for residents in care, documents collected include; resident roster, staff records, and resident records. Regarding the allegation that, facility staff are ignoring call buttons, the following has been concluded: LPA's conducted five resident interviews. Two out of the five residents were unable to be qualified for an interview. Another resident interviewed confirmed the allegation and stated that staff sometimes do not respond to their call button when they needs assistance. CONTINUED ON LIC9099-C Unsubstantiated However, two out of the five residents interviewed denied the allegation and stated that staff have always assisted them when they pressed their call button. LPA's conducted three staff interviews. Three out of the three staff interviewed denied the allegation and stated that staff immediately assist resident's when they press their call buttons. During the visit, LPA's tested the call buttons and observed them to be operational. LPA's also observed staff respond to the resident's when they pressed their call buttons. Due to the conflicting information received during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Jeannie Dao and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 28, 2026 · control 22-AS-20260121075045

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of issuing an amended report in connection to Complaint Control No: 22-AS-20251216150102. LPA met with Administrator Jeannie Dao and explained the reason for the visit. Amended report was explained and issued. LPA provided consult regarding the administrator's concerns. An exit interview was conducted with Administrator Jeannie Dao, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Jan 28, 2026

Allegation investigated: Lack of care and supervision Facility staff are not dispensing medications as prescribed Facility are not providing residents privacy

On January 21, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for a subsequent complaint investigation visit into the above allegations. LPA was greeted and granted entry after stating the purpose of the visit to staff. Administrator Jeannie Dao was contacted via telephone, notified about the reason for the visit, and granted permission for Caregiver Maria Perkins to sign the report. Regarding allegation, Lack of care and supervision, it is alleged that Resident 1 (R1) is sleeping in a recliner chair in the living room, resulting in falls and sustaining bruising. During visits conducted on December 29, 2025 and January 7, 2026, LPA observed R1 watching television and falling asleep on the recliner in the living room, after breakfast and lunch. On multipe ocassions throughout the visits, LPA observed staff in the living room, checking on R1 and attending to all residnets in care. Four out of four residents interviewed denied there being a lack of supervision at the facility as staff respond to their calls promptly and check on each person regularly. CONTINUE TO LIC9099-C.... Unfounded During an interview with R1, R1 stated they prefer to sleep in the recliner instead of the bed because it is more comfortable, they enjoy watching television, and also like to joke with staff and visitors while in the living room. R1 stated they have no pain and have not experienced any falls or bruises by sleeping in the chair. Four out of four witnesses denied the allegations stating stating R1 sometimes falls asleep while watching TV in the living room and has not sustained any falls or bruising as a result and also it is R1’s preference to sleep in the recliner. Three out of three staff denied the allegation, stating residents are responded to quickly and checked on regularly. Records were reviewed for R1, and LPA did not find any documentation noting R1 sustained falls or bruising due to sleeping in the recliner. Regarding the allegation, Facility staff are not dispensing medications as prescribed, it is alleged that facility staff are not administering eight medications prescribed for R1 and R1 is not being provided with the nasal spray. During the visit on January 7, 2026, LPA observed S1 dispensing medications and placing it in individual cups assigned to the residents which had their names. R1 stated during the interview confirming that the medications are administered during meal times, emptied into their hand, and then taking by mouth. Four out of four residents and three out of three staff interviewed stated that medications are administered timely. A record review of R1’s Physician’s Order Sheet dated December 29, 2025, documents R1 is prescribed twelve (12) routine and two (2) Pro Re Nata (PRN) medications. Based on the review of the Medication Administration Records (MARs), all medications were given appropriately and timely. Regarding allegation, Facility are not providing residents privacy, it is alleged that staff are not providing residents’ privacy during visitation and visits are being video recorded without consent. Based on the inspections, cameras were not present in the residents’ rooms. A working, disabled surveillance camera was observed in the kitchen area during previous visits, however was observed not in use and removed on January 7, 2026. Four out of four residents, which includes R1, denied the allegation stating that visits are uninterrupted and privacy is given. R1 stated staff have not video recorded any private visits and stated their family member utilized their phone to video record the staff instead. Three out of three staff denied recording residents and visitors in their bedrooms. CONTINUE TO LIC9099-C.... This agency has investigated the complaint, and based on observations made, interviews conducted, and records reviewed, the allegations, Lack of care and supervision and Facility are not providing residents privacy, are deemed UNFOUNDED. We have found that the above allegations are unfounded, meaning that the allegations are false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with Administrator Jeannie Dao and was granted permission for Caregiver Maria Perkins to sign the report. A copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jan 21, 2026 · control 22-AS-20251222133927

Allegation investigated: Staff are not giving residents their mail.

Regarding the allegation, Staff are not giving residents their mail, it is alleged that staff are not giving residents their mail. During interview conducted, four out of four residents confirmed receiving mail promptly if any and three of the residents confirmed that mail is still delivered to their previous address managed by their families. R1 stated all mail and legal documents are sent to R1’s family member. Three out of three staff denied the allegation stating residents are given their mail when it is delivered. Three out of four witnesses denied the allegation stating that the mail is received directly by the representatives at their respective locations and that the staff are forwarding the mail in a timely manner. A record review of R1’s Physician Report indicated R1 has a Dementia diagnosis. During visits to the facility, LPA did not observe any undelivered mail for R1. Based on observations, interviews, and records reviewed, although the allegation may have happened or are vaild, there not a proponderance of evidence to provie the alleged vionlations did or did not occur, therefore the above allegation is deemed UNSUBSTANTIATED. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 21, 2026 · control 22-AS-20251222133927

Allegation investigated: Facility staff did not communicate with resident’s family. Facility staff did not follow resident’s dietary restrictions.

Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of continuing the investigation into the above allegations. LPA was greeted by Caregiver Jesus Manalansan and stated the reason for the visit. During the course of investigation, LPA toured the physical plant, interviewed three witnesses, and five out of six residents. LPA was unable to obtain one resident's statement due to their medical condition. LPA obtained the following documentation for review: Resident Roster, Face Sheets, Physician's Reports, Admission Agreements, and menu. The investigation revealed the following: Regarding the allegation, Facilty staff did not communicate with resident's family, it is alleged that the families were not informed about the new owner of the business. Per interviews, four witnesses and two residents who are self-responsible confirmed the change in administrator from Staff #1 (S1) to Staff #2 (S2). The interviewed parties mentioned that the change in administrator was communicated individually either in person, by phone call, or via text. Unfounded Based on the interviews, four out of six residents, three witnesses, and three staff confirmed all utilities remain working and the licensee remains in control of the property. In review of the Department's Notice of Application Submission Status dated January 29, 2024, the licensee is the legal title holder of the property per the notarized grant deed dated October 23, 2025. The licensee sold the business to Staff #2 (S2) per the business purchase agreement on August 29, 2025. The term of the lease agreement dated September 1, 2025 between licensee and S2 began September 1st ending August 31, 2031. LPA received an email from S2 on January 20, 2026 reporting their resignation as business owner and administrator, withdrawing the application from the Centralized Applications Bureau (CAB), and endorsing Staff #3 (S3) as of the same day. Per review of the subsequent notarized business purchase agreement dated January 18, 2026, S3 entered into agreement purchasing the business from the licensee and S2 as of January 16, 2026. The term of the lease agreement dated January 15, 2026 between licensee and S3 begins February 1, 2026 ending February 1, 2031. As of today's date, S3 confirmed not submitting the application to CAB. Regarding the allegation, It is alleged that the Licensee has sold the facility without proper notice, it is alleged that the responsible parties were not given notice of the sale of the facility (or business). Based on the interviews, four witnesses and the two residents who are self-responsible, were informed about the change in management from Staff #1 (S1) to Staff #2 (S2) either in person, by phone call, or via text. Although, the residents and or their representatives were informed about the sale of the business, the licensee failed to issue proper written notices to the Department at least 30 days prior to the transfer. The investigation reveals that "control of property" is a requirement imposed on the licensee and applied continuously, meaning a licensee must maintain "control" for the duration of the license, and the Department may require evidence of control of the licensed property. In the case of losing control of property, the licensee lost control when the business was sold to S2 and subsequently S3. Additionally, the Department and residents and/or their representatives were not informed in writing at least sixty (60) days prior the transfer of business, or at the time that bona fide offer is made, whichever period is longer for both business transactions to S2 and S3. Therefore, based on the interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegations: Licensee has lost control of property and Licensee has sold the facility without proper notice are deemed SUBSTANTIATED. Deficiencies are being cited on the attached LIC9099-D. An exit interview was conducted with Caregiver Maria Perkins in person and Administrator Jeannie Dao via telephone, and a copy of this report including the appeal rights and Confidential Names (LIC811) were provided at exit. LPA reviewed the text messages sent to the responsible party who is the conservator of Resident #1 (R1) per the conservatorship document dated April 24, 2024. LPA confirmed that conservator of R1 was notified of the change of administrator via text message. Regarding the allegation, Facility staff did not follow resident's dietary restrictions, it is alleged that the facility fed R1 eggs and bacon causing R1 to be admitted to the hospital from a reaction. The complainant denied the allegation indicating R1 not having a special diet and food allergies which includes eggs and bacon. In review of the Physician's Report (LIC602), it is confirmed that R1 does not have a special diet prescribed by the doctor. Five out of six residents and three out of three witnesses reports residents receiving three meals a day with snacks in between and expressed no concerns. Therefore, this agency has investigated the complaint and based on the observations made, interviews which were conducted, and the records that were reviewed, the following allegations: Facility staff did not communicate with resident's family and Facility staff did not follow resident's dietary restrictions are deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with Caregiver Maria Perkins in person and Administrator Jeannie Dao via telephone, and a copy of this report including the Confidential Names (LIC811) were provided at exit.the state’s words, verbatim · CDSS document, Jan 21, 2026 · control 22-AS-20251216150102

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87112(a) · Plan of correction due date: Jan 30, 2026

87112 Conditions for Forfeiture of a License (a) Conditions for forfeiture of a residential care facility for the elderly license shall be as specified in Health and Safety Code section 1569.19. This requirement was not met as evidenced by: Based on interviews and the records reviewed, the licensee lost control of property when the business was transferred twice to S2 and subsequently S3 which poses a potential Health, Safety, and or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 21, 2026

Plan of correction: Administrator Dao stated that the application to apply for a license will be submitted to CAB and will provide proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87109(b) · Plan of correction due date: Jan 30, 2026

87109 Transferability of License (b) The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer... This requirement was not met as evidenced by: Based on interviews and the records reviewed, the Department and residents and/or their representatives were not notified of the transfer of the business within the required time above which poses a potential Health, Safety, and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 21, 2026

Plan of correction: Administrator Dao will submit a letter to the Department, residents, and/or their representatives immediatelly reporting the change in management and ownership of the business as well as an Acknowledgement of Understanding of the said regulation to LPA by POC due date.

Type of visit: Case Management - Deficiencies

On January 7, 2026, Licensing Program Analyst (LPA) Eboni Bentley made an unannounced Case Management visit for the purpose of issuing deficiencies. LPA was greeted and granted entry after stating the purpose of the visit to staff. Administrator Jasmin Garcia was contacted and arrived shortly to assist with the visit. Per review of staff files, the facility did not maintain staff records for Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3). Additionally S2 and S3 did not obtain their initial 40-hour training. LPA observed that the licensee did not maintain personnel records for S1, S2, and S3's personnel records and were incomplete. Deficiencies are being cited on the attached LIC9099-D. An exit interview was conducted Administrator Jasmin Garcia, and a copy of this report, LIC809-D, and LIC811 were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jan 7, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625 · Plan of correction due date: Feb 6, 2026

1569.625(b) (1) The department shall adopt regulations to require staff members of residential care facilities for residents ...... to receive appropriate training. This training shall consist of 40 hours of training. This requirement is not met as evidenced by: Based on observation, interview, and record review, the facility does not have a record of Staff #2-3 receiving initial training, which is a potential risk to persons in care.the state’s words, verbatim · CDSS document, Jan 7, 2026

Plan of correction: The administrator stated they will provide 40 hours Initial training to Staff #2, and Staff #3 by POC due date and send proof to CCLD via email to eboni.bentley@dss.ca.gov by February 6, 2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412 · Plan of correction due date: Feb 6, 2026

87412 (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:... This requirement is not met as evidenced by: Based on observation, interview, and record review, the facility does not have a record of Staff #1-3 personnel records, which is a potential risk to persons in care. LPA observed three out of three incomplete personnel records containing LIC 501 only.the state’s words, verbatim · CDSS document, Jan 7, 2026

Plan of correction: The administrator stated they will ensure all personnel records are complete and available for the Department review by POC due date and will send proof to CCLD via email to eboni.bentley@dss.ca.gov by February 6, 2026.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jessica Cho made an unannounced Case Management visit for the purpose of issuing a deficiency. LPA was greeted and granted entry by Caregiver Jesus Manalansan. Administrators Maria Avila, Jasmin Garcia, and Licensee Huan Luyen was advised of the reason for the visit by telephone. Per review of the Guardian Background Check System dated December 17, 2025 at 3:09pm, Staff #1 (S1) and Staff #2 were not associated to the facility at the time of review. Both S1 and S2 were associated approximately 4pm today. A deficiency is being cited and an Immediate Civil Penalty (ICP) is being assessed. An exit interview was conducted with Caregiver Maria Perkins, and copy of this report including the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Dec 17, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Dec 18, 2025

87355 Criminal Record Clearance (e) 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) This requirement was not met as evidenced by: Based on observation and record review, S1 and S2 were not associated prior to employment which poses an immediate Health, Safety, and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 17, 2025

Plan of correction: S1 and S2 were associated during the visit. Facility will submit a written Acknowlegdement of Understanding of the said deficiency to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hanna Gough arrived at the facility to conducted the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Jasmin Avila and discussed the purpose of the visit. The facility currently has 4 residents in care. The facility is a one story home with six resident bedrooms, two staff rooms, kitchen, living room, dining room, three bathrooms, attached 2 car garage and a backyard. Facility appears clean, safe and sanitary. LPA observed the required departmental postings throughout the facility. LPA observed residents napping and eating lunch. LPA observed activities for resident enjoyment. All resident bedrooms had the required components and furnishings. LPA observed the kitchen to be free of vermin. LPA observed the knives and sharps to be under the locked kitchen sink and made inaccessible to residents in care. LPA observed a seven day non perishable and two day perishable food supply on hand. LPA observed a fire extinguisher in the living room and kitchen charged and with a service date of March 19, 2025. LPA observed the centrally stored medication to be in the locked closet by the front door making them inaccessible to residents in care. LPA observed the resident bathrooms to have toilet paper, paper towels, and textured shower flooring. LPA tested the water to be at 115.7-115.8 degrees Fahrenheit. LPA observed clean linens in the hall closet located by the resident bedrooms. LPA observed the garage to be locked and made inaccessible to residents in care. LPA observed the toxins and chemicals to be stored in the locked garage. LPA observed the garage being used as a staff break area. LPA observed the backyard to be free of obstructions. LPA observed a shaded seating area for resident use. LPA observed the emergency food and water supply. LPA and AD tested the fire and carbon monoxide detectors and they were found to be operational. Continue on LIC 809-C LPA reviewed staff files, no discrepancies were observed. LPA reviewed resident files and no discrepancies were observed. LPA reviewed resident medications and no discrepancies were observed. LPA observed the last fire drill conducted on May 30, 2025. All staff present are background cleared and associated to the facility. Based on today’s observations, no deficiencies were noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Jasmin Avila and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 27, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jenifer Tirre made an announced inspection visit to follow up on corrections identified during Pre Licensing visit on 05/21/2024. LPA identified themselves and discussed the purpose of the visit with Licensee Maria Teresa Misa. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 1/29/2024. There are 0 residents in care during today's visit. LPA observed the following: At 11:35 AM LPA toured the facility and observed the following: · Let Us Know Poster is proper size 20x26 and posted near entrance · Facility has proper First Aid Handbook, Tweezers and Thermometer · Facility has obtained emergency water supply · Facility closed off passageway door from common area restroom and Caregiver room · Facility closed off door between two resident rooms · Facility has internet access device for residents use · Facility has operable land line phone. LPA conducted Component III during visit with Administrator Misa. Noted items from visit on 05/21/2024 have been addressed. The facility is ready to be licensed. Exit interview conducted with Administrator and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 30, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a single story residential home. LPA along with Administrator/Licensee Maria Teresa Misa toured facility at 1:05PM and observed the following: Structure: Facility is a one story, 8 bedroom (6 Residents bedrooms and 2 live in staff bedroom) 3 bathroom house with attached garage and a blue exterior. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: All resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Facility has 3 Fire extinguishers, mounted and fully charged. Facility has audible alarms on all sliding/exit doors. Appliances: Gas Stove, microwave and refrigerator are operational. Toxins: LPA observed toxins secured in laundry storage area.. Water Temperature: Tested and recorded at 113.1 degrees F. in facility bathrooms. Reading Material Games, and Equipment: facility does exercises, puzzles and games. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on both sides of facility as required. LPA observed shaded outdoor seating. Fire Clearance: Approved for 5 non-ambulatory residents and 1 bedridden on 04/15/2024. CONTINUED ON 809C Licensee to address the following corrections by 5/30/24: Let Us Know Poster is not regulation size, please have proper size poster 20x26 posted near entrance Facility needs First Aid Handbook, Tweezers and Thermometer Facility needs emergency water supply Facility to close off passageway door from common area restroom and Caregiver room Facility to close off door between two resident rooms Facility to provide internet access device for residents Facility to have operable land line phone. The facility is not ready to be licensed. Licensee to contact LPA when corrections are complete. Component III will be conducted at follow up visit. An exit interview was conducted with Licensee and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 21, 2024