La Posada in Glendora

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility. Upon arrival, LPA met with the Administrator Paula Mera and Clemencia Bousheri. The reason for the visit was explained. The facility is licensed as Residential Care for Elderly (RCFE) to serve six (6) non – ambulatory adults, ages from 60 years old and above, of which one (1) may be bedridden. The facility has approved two (2) hospice waivers. Facility fees are current. The facility consists of five (5) resident bedrooms, one (1) staff room, two (2) bathrooms, kitchen, dining room, office area, living room, shaded patio, and attached garage. The following were reviewed during this visit: Infection Control: Sufficient PPE supplies and an Infection Control Plan maintained at the facility were observed and in compliance. Physical Plant & Environment Safety: Physical plant tour was conducted. Residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The backyard, outdoor and passageways were free of obstruction and debris/hazards. Storage areas for cleaning solutions, toxins, knives, and hazardous items were kept in a locked cabinet and were inaccessible to residents. (-Continued on the LIC809-C) Water temperature was tested and the temperatures were between 105.8 to 119.7 degrees F., which is in compliance with regulations. Smoke detectors and carbon monoxide detectors were operable. Fire extinguishers were observed and fully charged. Operational Requirements and Disaster Preparedness: Facility has an activity area furnished for outdoor use. Fire drills were conducted monthly. The last fire drill was on 08/15/26. Staffing and Personnel Records- Training: There appears to be sufficient staffing at all times in the facility. Staff files were reviewed and in compliance. Administrator certificate is current with the expiration date on 11/22/2026. Resident Rights-Information and resident Records-Incident Reports: Facility provided telephone landline and internet for the residents. Resident rights posters and reporting posters were displayed within the facility. Food Service: The kitchen was observed to be clean. Two (2) days of perishables and one-week (7) days of non-perishables food supply were observed. Health Related Service: Medication was properly labeled, centrally stored, and in their original containers. Incidental Medical & Dental and Emergency Intervention: Staff designated to administer medication have the proper training on file. Residents at this facility do not need the use of restraints or de-escalation techniques, however, staff maintain a CPI Certificate in the case of use. Exit: No deficiencies were noted during this visit per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Administrator Paula Mera. LIC 809s were provided.the state’s words, verbatim · CDSS document, Sep 10, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced case management visit. LPA met with On-Call Administrator Clemencia Bousheri and the reason for the visit was explained. The purpose of the visit was to follow up on items addressed during the Noncompliance Conference (NCC) meeting held on October 1, 2025. The facility is licensed to serve age range 60 and over. Six (6) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver for two (2). The facility is operating within the scope of their license with six (6) residents, of which one (1) is receiving hospice care. The facility has dementia care for residents. The facility is a single-story home located in a residential area of Glendora. The front yard has secured perimeters in the form of a motorized gate to prevent residents from leaving the property. The home consists of five (5) resident bedrooms, 2 bathrooms, a kitchen, dining area, living room, office, shaded outdoor patio, and attached garage. LPA toured the facility and observed the following: The facility was observed to be clean and free of debris and obstructions. Water temperature was tested in the resident bathroom and measured at 117.1°F, which is within the required 105°F-120°F. Resident bedrooms were observed to contain the required furniture, linens and lighting. Linens were observed to be in good repair. continued on LIC 809C continued from LIC 809 The kitchen was observed to be clean and free of pests. Soaps, detergents, and cleaning supplies are stored separate from food supplies. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Combination smoke and carbon monoxide detectors were observed throughout facility. LPA reviewed six (6) resident files and four (4) staff files. Files were observed to be complete and contained the required documentation. LPA reviewed log for emergency drills. Last fire/earthquake drill was conducted October 2025. Per California Code of Regulations, Title 22, and California Health and Safety Code, there are no deficiencies observed during today’s visit. Exit interview held and a copy of this report was provided to Clemencia Bousherithe state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: Office

A noncompliance conference was conducted with the Licensee, Rafael Diaz for D & L Residential Care Home 1, D & L Residential Care Home 2, and La Posada in Glendora at the Monterey Park Adult and Senior Care Community Care Licensing Office. The purpose of the meeting was to discuss concerns regarding the overall operation of these facilities. The attendees present during the meeting were: Community Care Licensing Regional Manager (RM) Tony Vasallo, Licensing Program Manager (LPM) Adeline Ho, Licensing Program Analyst (LPA) Blanca Gonzalez, and Licensee Rafael Diaz. The licensee currently operates three facilities: D & L Residential Care Home 1 facility # 198602638, D & L Residential Care Home 2 1 facility # 198602639 and La Posada in Glendora 1 facility # 198603124. The attendees discussed the following concerns: • Overdue annual fees • Disproportionate amount of violations • Licensee is not submitting plan of corrections and has submitted incomplete plan of corrections. • Licensee submitted incomplete packets for change of Administrator for D & L Residential Care Home 1, D & L Residential Care Home 2, and La Posada in Glendora • Suspended entities- D & L Medical and L & R Medical are currently suspended. • Background clearance • Civil penalties continued on LIC 809C Licensee understands that Community Care Licensing has placed the facility in a 12 month monitoring compliance plan. Licensee agrees to pay licensing fees and penalties that are due on time Licensee will follow up with LPA Christian Gutierrez to clear citations issued for D & L Residential Care Home 1 annual inspection visit Licensee agrees to comply with reporting requirements and will notify CCL when a bona fide offer is received for La Posada in Glendora Licensee confirmed current addresses on file are correct. Licensee agrees to inform CCL of any changes Licensee agrees to submit completed packets for Administrator changes by 10/02/2025; Board Resolution for D & L Residential Care Home 1 and D & L Residential Care Home 2 and La Posada in Glendora along with a copy of Paula Mera's Driver License Licensee agrees to resolve issue with Secretary of State/ FTB regarding D & L Medical and L & R Medical within 6 to 9 months. Licensee will provide CCL with updates via email every three months. Further details are included in the non-compliance report. The licensee agrees to be placed on a twelve-month monitoring plan with Licensing. Licensee has been advised that failure to complete the above agreed upon actions by the dates and/or continued non-compliance may result in this Department taking additional actions. This case may be referred to CCLDs’ Legal Division. Such referral may result in the filing of an administrative action before the Office of Administrative Law Licensee was provided with copy of Title 22 section 87156, 87205, 87756, 87758,87759, 87761,87766, 87775, and 87777, Exit Interview conducted. A copy of report was given to the licensee, Rafael Diaz.the state’s words, verbatim · CDSS document, Oct 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met Assistant Administrator Paula Mera and explained reason for visit. The facility is a home located in a residential area. It is licensed to serve six (6) non-ambulatory residents, of ages 60 and over, of which one (1) may be bedridden. The facility has dementia care for residents and an approved hospice waiver for 3 residents. The facility has secured perimeters in the form of a motorized gate in the front to prevent residents from leaving the property. The home consists of five (5) resident bedrooms, one (1) which is a shared room, staff room,2 bathrooms, a kitchen, dining room, office area, living room, shaded patio, and attached garage. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. LPA observed full bed rails for three (3) residents not on hospice care. Smoke detectors/carbon monoxide detectors were observed in each room and throughout facility. The facility has two (2) fire extinguishers that are fully charged. Cleaning supplies and toxic substances are inaccessible locked in garage. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grab bars and non-skid mats. The hot water temperature in the bathrooms were not measured between the required range of 105-120 degrees F. The common areas, including the living room and dining area, are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. SEE LIC 809C Three staff files reviewed included Criminal clearance record, health screening with TB, and CPR/First Aid. Administrator file was not available at time of visit. Two out of five (5) resident files were reviewed and were missing TB clearance.No fire/earthquake drill was available. Infectious control plan was reviewed. Resident medications were reviewed three (3) out of four (4) residents were missing medication that was listed on MAR log. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview was held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: POC

Licensing Program Analysts (LPAs) Elena Mallett & Luis De Leon, and Licensing Program Manager (LPM) Fernando Fierros conducted an unannounced Plan of Correction (POC) visit for citations issued on 9/2/2022. LPAs was greeted by current Administrator Paula Mera and the purpose for today’s visit was explained. On 9/2/2022 the facility was issued a citation for the following: 87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. The requirement was met as evidence by: During visit on 5/9/25 LPAs and LPM reviewed the resident record files for six (6) out of six (6) residents and found that all residents have a medical assessment within one year, which includes four (4) residents with a diagnosis of Dementia. 87465 Incidental Medical and Dental Care (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file... The requirement was met as evidence by: During visit on 5/9/25 LPAs and LPM reviewed the resident record files for six (6) out of six (6) residents and found that all residents have a written prescription orders issued by their medical providers. 87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. The requirement was met as evidence by: During visit on 5/9/25 LPAs and LPM reviewed the resident record files for six (6) out of six (6) residents and facility was able to produce each file located at facility. Exit interview was conducted with Administrator Paula Mera. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 9, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Elena Mallett & Luis De Leon, and Licensing Program Manager (LPM) Fernando Fierros conducted an unannounced case management visit to check facility compliance for hospice waiver request per title 22. LPAs was greeted by current Administrator Paula Mera and the purpose for today’s visit was explained. FACILITY PHYSICAL PLANT The facility is in a residential area. The facility is made up of five (5) client bedrooms and one (1) staff room, one (1) full bathroom for residents and one (1) full bathroom for staff, living room, dining room, laundry room, front shaded porch, and backyard, and an attached car garage. There were no body of water observed in the property. The facility has charged fire extinguishers. The building contains central air conditioning and heating. REVIEW OF FILES Resident record review consisted of Physicians Report for six (6) out of six (6) residents, hospice plan for four (4) out (6) residents, and medication written orders for six (6) out of (6) residents. During the visit, Administrator Paula Mera reported the passing of resident R3 the night before 5/8/2025. Administrator will send CCLD a death report for R3 and document cause of death for hospice reason care . Staff roster and staff facility association were reviewed. Report continues on page 809C... Observations during facility tour with assistance of Administrator Mera.: · Upon arrival, auditory device at main entrance was not working when door is opened. Per California Code Regulations, Title 22, facilities with dementia residents are required to have an auditory device to monitor exits on exterior doors. · Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPA observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for clients. The facility has full bedrail orders for four (4) out of six (6) residents (R1-3, 5). Wall and floors are in good repair. Hallways were clean and free of obstructions. · Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable food. Dining room has sufficient seating area. · Toilets, showers, and water faucets are cleaned and free of mold. Restrooms were stocked and clean. The water temperature was tested and measured. A deficiency is noted for hot water in the resident restroom measured 124.1 and 124.5 for both sinks which is above the regulatory requirements in California Code of Regulation, Title 22. · Disinfectants and sharps were observed in the garage and accessible to residents with Dementia. Therefore, a deficiency is noted on page 809D. · Smoke detectors were observed in all bedrooms and carbon monoxide detectors was observed in the living room leading up to the bedrooms. All smoke detectors are interconnected throughout the facility. Two (2) fire extinguishers were observed at kitchen and garage and were fully charged. · Front and back yards have shaded seating area. · The medications are centrally stored and locked in the office. LPAs and LPM review the request for increase of hospice waiver request with Administrator. Due to deficiencies noted during visit. The administrator will a request a hospice exception for resident who aged in place at the facility but has started hospice care. The administrator stated that facility will rescind hospice waiver request and, instead, submit the hospice exception request to the department by 05/12/25.. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D pages. Exit interview held and a copy of the reports (809, 809C, 809D and appeal rights) along with appeal rights were provided to Administrator Paula Mera.the state’s words, verbatim · CDSS document, May 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: May 10, 2025

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device... alert feature to monitor exits on exterior doors ... accessible to those residents who may be at risk for elopement... This requirement is not met as evidenced by: Based on LPAs observation and record review, the licensee did not comply with the section cited above in four (4) out six (6) residents with dementia who had access to the main entrance door and there was no operable auditory device which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 9, 2025

Plan of correction: Facility will fix auditory device by changing battery. Deficiency was fixed during visit and it was tested. Auditory device is now functioning properly.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(f)(1) · Plan of correction due date: May 10, 2025

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Based LPAs observations, the licensee did not comply with the section cited above in that the desinfectant, knives and sharps were accessible to residents with Dementia and stored in the garage, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 9, 2025

Plan of correction: Facility will secured sharps and desinfectant in a secured room at the garage. Administrator moved sharps and desinfectant inside a locked room within the garage. Deficiency was clear at time of visit

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: May 10, 2025

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based LPA observation, the licensee did not comply with the section cited above as hot water temperature in resident’s bathroom measured at 124.1- and 124.5-degrees F during today’s visit, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 9, 2025

Plan of correction: Maintenance staff will regulate water temperature tank today. Facility will monitor water temperature for 3 days to ensure water temperature is within Title 22 regulation, and will send water temperature log to CCLD by 5/13/25.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Administrator, Paula Mera, who assisted with the visit. The facility is licensed to serve residents ages 60 and above, with a capacity of six (6) residents including six (6) non-ambulatory of which one (1) may be bedridden. The facility had dementia care program. Annual fees were current. Hospice waivers were approved for two (2) residents. Currently, there are three (3) hospice residents residing at the facility. For today’s inspection visit, the CARE tool was used; a physical plant was conducted; food supply was reviewed; staff/residents were interviewed; and staff/residents’ facility records along with medications were reviewed. Administrator certificate is current with expiration date on 11/22/24. The facility was located in a residential neighborhood. The facility consisted of five (5) resident bedrooms, one (1) which is a shared room, two (2) bathrooms, a kitchen, dining room, office area, living room, shaded patio, and attached garage. The facility had secured perimeters with a motorized gate in the front to prevent residents from leaving the property. All the rooms were furnished with appropriate furniture for residents’ comfort. (-continued in LIC 809C-) The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was 119.8 degrees Fahrenheit. Adequate linen and personal hygiene supplies were observed. No pools and bodies of water on the premises. Facility maintained a comfortable temperature for residents. Interior and exterior space available to permit residents to wander freely and safely. Sufficient supplies of perishable and nonperishable foods were observed. Knives, tools, sharp items were inaccessible to residents. Smoke detectors and carbon monoxide detectors were operable. Fire extinguishers were fully charged. Medication, residents’/ staff’s records were centrally stored in a locked cabinet and inaccessible to residents. Toxic substances were inaccessible to residents. Deficiencies were observed and cited per California Code of Regulations, Title 22, in LIC 809 D. An exit interview was conducted. This report and Appeal rights were discussed and provided to administrator Paula.the state’s words, verbatim · CDSS document, Aug 30, 2024