Lake Canyon Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Angelica Boyles conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Lorna Acorin. Administrator Chona Simsuangco later joined the visit. According to the facility’s license, the facility serves residents age 60 and over and has a maximum capacity of 6 residents, all of whom may be non-ambulatory, and one may be bedridden. The facility has been granted a hospice waiver for 2. LPA accompanied by Administrator, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC 809) No pools or bodies of water were observed on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed staff and resident files. The reviewed files contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited on today's visit. An exit interview was conducted with Administrator Chona Simsuangco, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, May 11, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Debbie Correia conducted an announced Pre-Licensing/Component III inspection at the facility. LPA was greeted at the front door by Applicant Chona Simsuangco, identified herself and was granted entry. Administrator Leonardo Simsuangco was also present during the inspection. The facility received fire clearance on February 26, 2025. The facility was approved for a capacity of six (6) residents (ages 60 and above), all of which can be non-ambulatory and one (1) bed-ridden to be housed in bedroom #3. LPA Correia, accompanied by Applicant Chona and Leonardo Simsuangco, conducted an overall inspection/tour of the facility inside and out, and a facility records review. During the facility tour LPA Correia observed the facility is equipped with fire extinguishers, smoke alarms and carbon monoxide detectors that were all operational and up to date. LPA also observed emergency lighting, first aid kit and manual, and hallway night-lights. The facility bedrooms for residents in care are furnished appropriately, including padded mattress covers, dressers and closet space, and lighting. Bathrooms are equipped with grab-bars, non-skid flooring for showering. [Continued on LIC809C] Locked cabinets were present for medications, toxins, cleaning supplies, and records. Taps accessible to residents in care measured within regulation at 109.6 and 111.4. The facilities ambient temperature was 69 degrees Fahrenheit. The facility was observed to be sanitary and in good repair. No obstruction of pathways or bodies of water were observed on the premises. There is facility has extra linens and toiletries, and Personal Protective Equipment(PPE). LPA also observed the required postings, ample room for activities and visitation, and an outdoor shaded area. The facility also has a prepared monthly menu for meals, and activities schedule. LPA also observed the required postings, ample room for activities and visitation, and an outdoor shaded area. The facility also has a prepared monthly menu for meals, and activities schedule. Per applicants there will be no firearms or ammunition kept on the premises. The Pre-Licensing and Component III was completed on today’s date. The facility is ready for licensure pending management approval. An exit interview was conducted with Applicant Chona Simsuangco. A copy of this report along with the licensee Rights (LIC 9058 01/16) will be provided at the conclusion of the visit. Signature on this form confirms receipt of the reports.the state’s words, verbatim · CDSS document, Jun 4, 2025