Lagoon Home Care

Type of visit: Case Management - Other

On 7/30/2026, Licensing Program Analyst (LPA) Mary Rico conducted unannounced case management visit. LPA met with staff Dialila Palafox and explained the purpose of the visit. The visit pertained to the complaint control number 56-AS-20260507080944. LPA Rico obtained copies of pending documents. An exit interview was conducted, and this report was discussed and provided staff Saidia Wakil Chaudhri.the state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Case Management - Deficiencies

On 7/1/2026, Licensing Program Analysts (LPAs) Mary Rico and Matthew Aguilar conducted an unannounced case management visit. LPA Rico met Administrator Rustico De Guzman and explained the purpose of the visit. The visit pertained to the complaint control number 56-AS-20260507080944. LPA Rico review facility documents and interview staff. During record review, LPAs observed S1 and S2 criminal clearance were not associated to Lagoon Home Care. LPA requested for S1 and S2 to be associated to the facility. In addition, LPA Rico requested documents for R1. The Administrator stated they were unable to locate the file at the facility. LPA Rico informed the Administrator that former residents file must remain at the facility for three years. During facility tour, LPA Rico observed cleaning chemicals not locked inside resident bathroom. Based on the observations made during today’s visit, (3) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809)(LIC809D)(LIC421FC) and Appeal Rights was discussed and provided Administrator Rustico De Guzman.the state’s words, verbatim · CDSS document, Jul 1, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Jul 2, 2026

Criminal Record Clearance 87355(e)(3) All individuals subject to a criminal record .. 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) Based on LPA observation, and record review, the licensee did not comply with the section cited above S1 and S2 is not associated with the facility which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: Administrator stated send transfer request to Community Care Licesning and send proof to LPA Rico. POC 7/2/2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Jul 2, 2026

87309(a) Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning , sharp objects, a danger to residents are in locked storage and are not left unattended if outside the locked storag Based on LPA observation, and record review, the licensee did not comply by having cleaning solutions under the bathroom sink not locked which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: The Administrator stated they will have an in-service training with all staff. A copy will be provided to LPA Rico/ POC 7/2/2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(e) · Plan of correction due date: Jul 8, 2026

87506(e) Resident Records (e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. Based on record review, and interview the licensee did not comply with the section cited above by not having R1 records which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: The Administrator they will provide R1 file to LPA Rico via-email. POC due date 7/8/2026

Allegation investigated: Staff illegally evicted a resident in care.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver the findings on the allegation listed above. LPA met with Administrator Dulce Redford and explained the purpose of today’s visit. The investigation consisted of staff interviews, resident interviews and record review. For the allegation, Staff illegally evicted a resident in care. During staff interviews 2 out of the 2 staff stated R1 was not illegally evicted and remains at the facility. Both staff also stated that R1 was sent to the hospital by residents and family requests. During resident interview, R1 stated that they had requested to be sent out to the hospital. In addition, LPA Rico conducted an interview with R1 responsible party, they had also confirmed they had requested for R1 to seek medical attention at the hospital. During facility tour, LPA Rico observed R1 at the facility. In addition, all personal belongings remained at the facility. Unsubstantiated Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. 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 (LIC9099) was discussed and provided to Administrator Ducle Redford.the state’s words, verbatim · CDSS document, Feb 20, 2026 · control 56-AS-20260219172751

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator Ducle Redford and was granted entry to the facility. Licensed capacity is (6) current census (5). LPA was accompanied by , Administrator Ducle Redford 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. 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. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents . Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) resident file for admission agreements, updated physician reports, needs/ services plans and (1) Hospice file. LPA also verified (3) resident's medications. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screening. 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 Administrator Ducle Redford.the state’s words, verbatim · CDSS document, Jan 30, 2026

Allegation investigated: Staff did not ensure resident needs were met

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Caregiver Marlene Ocampo and explained the purpose of the visit regarding the allegations listed above. First allegation: Staff did not ensure resident needs were met. Regarding the allegation LPA conducted interviews with Resident #2 and R#3 LPA went over the alleged allegation with the residents and both residents informed LPA that facility meets their needs daily and have no concerns regarding their needs or care. Furthermore, R#2 and R#3 informed LPA that facility staff is very friendly and take good care of all residents. LPA conducted an interview with Staff #1 and S#2 LPA went over the alleged allegation with S#1 and S#2 and both S#1 and S#2 denied the allegation and informed LPA that R#1 needs were met daily. In addition, Staff #1 and S#1 denied witnessing staff not meeting the needs of the residents. LPA conducted an over the phone interview with R#1 Responsible Party/Power of Attorney LPA went over the alleged allegation with R#1 POA LPA was informed by R#1 POA that the allegations and concerns are not against the facility but rather against the hospital where R#1 was receiving care prior to being admitted to the facility. LPA conducted a walkthrough of the facility and observed facility to be clean, in good repair, and operating in safe conditions for residents in care. LPA observed enough food supply to be stored to meet the needs of residents in care. Based on corroborating evidence the department has determined that the above allegations are Unsubstantiated, meaning that 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. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Unsubstantiated LPA conducted an over the phone interview with R#1 Responsible Party/Power of Attorney LPA went over the alleged allegation with R#1 POA LPA was informed by R#1 POA that the allegations and concerns are not against the facility but rather against the hospital where R#1 was receiving care prior to being admitted to the facility. LPA conducted a walkthrough of the facility and observed facility to be clean, in good repair, and operating in safe conditions for residents in care. LPA observed enough food supply to be stored to meet the needs of residents in care. Based on corroborating evidence the department has determined that the above allegations are Unsubstantiated, meaning that 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. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Caregiver Marlene Ocampo.the state’s words, verbatim · CDSS document, Jan 7, 2026 · control 56-AS-20251224175509

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Mary Rico conducted an announced visit to complete a pre-licensing inspection and component III. LPA met with Licensee/Administrator Ducle Redford. The pending application is for a Residential Care Facility for the Elderly (RCFE). The approved fire clearance granted for(5) non-Ambulatory and (1) bedridden 11/12/2024. The interior and exterior were toured of the pending facility. Overall, the pending facility is clean and in good condition. LPA observed all bedrooms to be appropriately furnished with adequate lighting. Bathroom toilets, showers have non-skid mats. LPA observed food storage and preparation areas to be clean and sanitary. Refrigerator and freezer temperatures are maintained at appropriate temperatures. All appliances are clean and operating properly. There is a sufficient supply of linens, towels, and personal hygiene items. The first aid kit was reviewed; all items are present including a First Aid Manual. LPA observed an adequate supply of recreation and leisure items and activities. The backyard is completely enclosed with functioning gate to exit to front yard. Outdoor space is suitable for resident use that includes a covered patio with a table and chairs. LPA observed the fire extinguishers to be recently serviced and completely charged. Smoke alarms and carbon monoxide detectors are present and functional. Medications will be centrally stored and secured in a locked cabinet. All hazardous materials such as, cleaning, and disinfecting supplies, knives and other sharps are locked and inaccessible to residents. All required forms are posted in a common area. Pre-Licensing Inspection and Comp III is complete. The facility has no deficiencies. No corrections need to be made. An exit interview was conducted where this report was discussed and provided to Licensee Dulce Redford.the state’s words, verbatim · CDSS document, Feb 18, 2025