Just Like You Are Home 3

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Eleonor De Leon. Administrator (AD) Alicia Lira arrived shortly after. For today’s visit, LPA observed a total of five residents in care and two staff members on duty. LPA Ramirez toured the interior and exterior portions of the facility with AD Lira. LPA observed the AD certificate for AD Lira which expires on December 14, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for three. The facility is a single story home with four resident bedrooms, two of which are shared, two and a half bathrooms, a living room, a family room, a dining room, a kitchen, a laundry room, a shaded porch, and an unattached two car garage. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Three residents are currently using half-rails for postural support. Appropriate physician orders on file for the three residents. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. Bathrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 106.8-107.4 degrees Fahrenheit. LPA observed that the electric stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. CONTINUED ON LIC809-C... Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Fire extinguishers were charged, and had a service tag dated May 15, 2026. One fire extinguisher was located by the bedrooms' hallway and one by the kitchen. LPA Ramirez observed the emergency disaster and evacuation plan, which is posted by the bedrooms' hallway. Licensee was advised to updated the Emergency Distaste Plan (LIC610E) dated December 2025. Facility had back-up emergency food and water supply, located in the kitchen. LPA observed that the First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. Medications are locked in a cabinet by the dining room. Oxygen is currently in use with adequate signs on display. There are no bedridden residents present on the premises. During today's visit LPA observed the residents watching television in the living room and/or relaxing in their bedroom. For the exterior portion, LPA Ramirez observed a shaded patio area with furniture, and the grounds were free of any hazards. There is one gate in the backyard, which is self-closing and self-latching. No bodies of water were observed. LPA reviewed five resident files and three staff files. LPA interviewed residents and staff present. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Lira. A copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Aug 14, 2026

Type of visit: Required - 1 Year

On August 28, 2025, Licensing Program Analysts (LPAs) Brandon Lopez and Garlli Tat made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Alicia Lira was notified via telephone and later arrived to assist with the inspection. LPAs observed that Alicia Lira has a valid Administrator certificate which expires on December 14, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for three. The facility is a single story home with four resident bedrooms, two of which are shared, two and a half resident bathrooms, a living room, a family room, a dining room, a kitchen, a laundry room, a screened porch, and an unattached two car garage. LPAs, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPAs observed six residents in care and two care giving staff present. LPAs observed residents watching TV in the family room and relaxing in their respective bedrooms. LPAs observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPAs inspected all four resident bedrooms and observed them to be free of hazards. LPAs observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPAs observed resident beds to have clean linens and blankets. LPAs observed additional linens to be stored in a hallway closet. LPAs inspected the two and a half resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 120.3 and 120.7 degrees Fahrenheit. LPAs observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPAs observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C LPAs observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPAs observed fire extinguishers to be mounted on the wall in the kitchen and in the resident hallway. Fire extinguishers were observed to be charged and serviced as of May 16, 2025. LPAs tested the individual smoke detectors/carbon monoxide detectors which tested operational. LPAs observed the facility conducted their most recent emergency disaster drill on July 15, 2025. LPAs observed the centrally stored medication to be kept in a locked cabinet in the dining room. LPAs observed the facility also has a First Aid Kit stored in the locked cabinet in the dining room and it had all the required components. LPAs observed chemicals and toxins to be stored in a locked cabinet in the laundry room. LPAs observed the facility has a three day emergency food and water supply stored in a cabinet near the dining room. LPAs observed the screened porch to be clear of any hazards. LPAs, accompanied by the AD, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPAs observed a shaded outdoor seating area with furniture for resident use. LPAs observed the perimeter gate of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPAs observed the unattached two car garage to be used for storage. LPAs reviewed all six resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPAs reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Alicia Lira and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Alvaro Ramirez, Jr. conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicant Stevelyn Reroma and toured the facility. An application for Change of Ownership (CHOW) to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on February 29, 2024. The facility is to have a capacity of 6 residents, (0) ambulatory, (6) non-ambulatory and (0) bedridden residents. Facility phone number 714-202-5080 LPA observed the following. Structure: The facility is a one-story house with four resident bedrooms, two full size bathrooms, a half bathroom, a living room, a family room, a kitchen, a dining room, and an attached car garage. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall by entryway. There is one gate in the backyard, which both is self-closing and self-latching. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are four Resident bedrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. CONTINUED ON LIC809-C... Bathrooms: All bathrooms are clean and have working plumbing. Hot water measured between 106.5-108.2 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen for each resident was stored in the closet by the resident's bedroom hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Monthly menu available and posted in the refrigerator. Food Service: There are six residents living in the facility at this time. A supply of 2-day perishable and 7-day of non-perishable food was observed and will be maintained on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. Fire extinguishers were charged, mounted and one was located by the kitchen and one by the resident's bedroom hallway. Appliances: There is one electric burner stove which lights unassisted, one oven, microwave oven mounted above the stove, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored in the laundry room. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 106.5-108.2 degrees Fahrenheit. Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in a cabinet next to the dining room. The first aid kit has all the required elements. Medications will be stored in locked cabinet next to dining room. Resident & Staff Files: The Resident and Staff Records will be kept in a cabinet next to the dining room. Reading Material, Games, Equipment & Materials: Board games, puzzles, crossword and card games are stored in the living room cabinet. There is one large screen television in the living room. Fire clearance: Fire Clearance approved by a fire inspector of Orange City Fire Department on May 15, 2024. Special conditions noted, "Fire clearance approved under the above noted conditions. Rooms #1 and #2 non-ambulatory clients in each room while rooms #3 and #4 will have 1 non-ambulatory client in each room." Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Aug 9, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHANGE OF OWNERSHIP Capacity: 6 Census (if any clients in care): 6 COMP II Participants: RODA PADERNA, STEVELYN REROMA Interview Method: Telephone interview On July 09, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 9, 2024