Kaela's Home for Elderly

Type of visit: Required - 1 Year

On August 6, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Licensee (LICEN) Ser Paris Dumaliang. The facility is licensed to have a capacity of six (6) nonambulatory residents, of which one (1) may be bedridden, and a hospice waiver for six (6) residents. LPA Kim observed the following. The facility is a one-story house with an attached 2-car garage with five (5) resident bedrooms, one (1) staff bedroom, five (5) bathrooms, dining room, a kitchen, a living room, and outdoor shaded area. LPA Kim toured inside and outside of the physical plant. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be clean and operational. The water temperature in one out of four resident bedrooms measured at 124.1 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water and emergency supplies are stored in the garage. All mandated inspection control posters were posted. The facility has smoke detectors and carbon monoxide detectors that were operable. The Certificate of Liability Insurance is effective from October 25, 2025, to October 25, 2026. The facility did not have a current or completed Fire/Safety Drills logs at the time of the visit. One (1) fire extinguishers is mounted in the kitchen. A working telephone Facility phone number (949-446-4085) and tablet device dedicated to the residents both remain available. First Aid Kit contained all the necessary elements. LPA Kim conducted an audit of six (6) residents (R1-R6) files, and seven (7) staff (S1-S7) personnel files, and medication and medication administration records LPA observed R1 did not have a medical assessment in their file. LPA conducted interviews with two residents and two staff. S1 stated they pulled out a pullout bed to the living room or garage to sleep at the facility. Based on today’s visit, deficiencies were cited as per the Title 22 Division 6 Chapter 8 of California Code of Regulations (CCR). LPA observed a resident’s bathroom hot water temperature measured at 124.1 degrees F. LPA observed R1 did not have a medical assessment in their file at the time of the visit. LPA observed the facility did not have a completed emergency drill logs in their facility file at the time of the visit. LPA interviewed S1 who stated that they pulled a pullout bed to sleep in the living room or garage to sleep in. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Ser Paris Dumaliang.the state’s words, verbatim · CDSS document, Aug 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Celine Rodriguez and Garlli Tat conducted an unannounced visit for the required annual inspection. LPAs explained the purpose of today’s visit, and was greeted and granted entry by staff on duty (S1), and LPAs met with facility administrator (AD) Czarina Dumaliang about visit. For today’s visit, LPAs observed a total of 4 residents in care and 2 staff members on duty, of which both staff members were background cleared and associated via Guardian. LPAs observed the Administrator's Certificate for Czarina Dumaliang which expires on 3/10/2026. LPAs observed the PUB 475 "See Something Say Something" poster located at the entrance of the facility. LPAs toured the interior and exterior portions of the facility with S1. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 6 may be on hospice, of which 1 may be bedridden in room 3. There are a total of 6 bedrooms of which 4 are private resident rooms, 1 shared resident room, and 1 private room designated for staff. LPAs 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. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 5 restrooms in the facility. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was observed to be 116.8 degrees Fahrenheit. Continued on LIC809-C... Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Fire extinguisher was charged, mounted, located in the kitchen and dated for July 2025. LPAs observed the emergency disaster and evacuation plan, which is located by main entrance. LPAs observed that facility has emergency food and water supply located in the garage. LPAs observed that First Aid Kit had all the required components. LPAs observed that medications, toxins and sharps were locked and inaccessible to residents in care. For the exterior portion, LPAs observed grounds free of hazards. LPAs observed patio furniture under a shaded area, 1 gate which is self-closing and self-latching. No bodies of water observed. LPAs reviewed all 4 resident files. 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 Dumaliang. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Aug 5, 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 Czarina Dumaliang and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on January 17, 2024. The facility is to have a capacity of 6, of which 5 can be nonambulatory and 1 bedridden. Facility phone number 949-446-4085. LPA observed the following. Structure: The facility is a one-story house with five resident bedrooms, one staff bedroom, three full size bathrooms, two half bathrooms, a living 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 in the entranceway. There is a backyard with an exit gate. 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 five 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 107.3 and 109.5 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen was stored in a closet by the residents' 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. Menu posted and available. Monthly menu available and posted in the kitchen. Food Service: There are no residents living in the facility at this time. There is 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There is a fire extinguisher mounted on the wall by the living room. Appliances: There is one, four electric burner stove which lights unassisted, one oven, one microwave, 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 garage and laundry room. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 107.3 and 109.5 degrees Fahrenheit. Medications, First-Aid Kit & Book: Medications, the first aid kit and the first aid manual will be stored in a locked closet by the residents' bedroom hallway. The first aid kit has all the required elements. Resident & Staff Files: The Resident and Staff Records will be kept in a locked closet by the residents' bedroom hallway. Reading Material, Games, Equipment & Materials: Arts and craft, board games and light exercise equipment 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 County Fire Authority on March 05, 2024. Special conditions noted, "Bedridden client located in Room #3." 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 Central Applications Bureau (CAB) 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, Jul 12, 2024

Type of visit: Office

Facility Type: RCFE Application Type:Initial Capacity:6 Census (if any clients in care):N/A COMP II Participants: Name, Title Interview Method: Telephone interview On [05/31/2024], applicant(s)/administrator participated in COMP II for the below pending facilities: [list out all of the applicable pending applications in the following format: FACILITY NAME/FACILITY #, ex. Front Street Facility/123456789, Back Alley Facility/987654321, etc…]. Identification of the applicant(s) and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant(s) and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. 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. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 31, 2024