Live in Serenity

Type of visit: POC

Licensing Program Analyst (LPA) Marcella Tarin conducted a Plan of Correction (POC) case management visit to clear a deficiency cited on March 9, 2026. LPA met with Designated Administrator Jason Arcilla and Licensee/Administrator Jesus Arcilla. LPA stated the purpose of the visit. The facility was cited the following Type A deficiency on March 9, 2026 87355 Criminal Record Clearance (e) POC due date March 10, 2026 LPA received POC for type A deficiency. A letter of Deficiencies Citations Cleared was provided to Designated Administrator Jason Arcilla during today’s visit. No deficiencies was cited during today’s visit per California Code of Regulations, Title 22. An exit interview was conducted with Designated Administrator and Licensee/Administrator. A copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Staff Jason Arcilla, Staff Sarah Galura, and Staff Minerva Velasco. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with Staff to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA observed the facility to be clean, safe, sanitary and in good repair. LPA toured Building 1 and Building 2 of the facility. Each kitchen area was observed with a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed each refrigerator temperature at 37 F and Freezer at 0 F in both kitchens. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care in both Buildings 1 and 2. The facility was equipped with smoke and carbon monoxide detectors. The smoke detector/fire system was inspected by a third party vendor on 2/26/2026, and passed inspection. Fire extinguishers were last serviced on 9/16/2025 in Buildings 1 and 2. The facility emergency drill log was reviewed. The facility's last drill was on 1/16/2026. Page 1 of 2 LPA toured 6 resident bedrooms (3 in Building 1, and 3 in Building 2). All 6 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA toured 2 bathrooms. All 2 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range of 109.4 F to 117.3 F. LPA reviewed 3 resident records. Resident records included emergency contact information, physician’s report, needs and service plans, and personal rights. LPA reviewed 2 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 3 staff records. 2 Out of 3 Staff records included fingerprint background clearance, medical assessment with TB result, personnel record. Staff Minerva stated training records were in an online system and would provide copies of 3 staff training records to CCL by 3/10/2026. LPA also observed that S1's file did not contain a fingerprint background clearance. Staff Minerva stated S1 did not complete his/her fingerprints. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for S1 working in the facility without receiving a criminal record background clearance. An exit interview was conducted with Staff Minerva Velasco and a copy of this report and appeal rights were provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Mar 9, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced Case Management visit to follow up on the facility's capacity increase request. LPA met with Licensee Jesus Arcilla and Administrator (ADM) Minerva Velasco. LPA stated the purpose of the visit. On 07/18/2025 the Department received a capacity increase request from Licensee Josephine Arcilla. Licensee requested an increase in capacity from eight (8) to thirty-two (32) on 7/14/2025. This facility has 2 separate buildings, Building #1 and Building #2, which share the same address. Licensee requested 1 ambulatory, and 31 bedridden, with a total capacity of 32. A Fire Clearance request was submitted to the local fire department on 8/26/2025. On 12/29/2025 the Department received the fire clearance approval: Building 1-Rooms 1-4, and 6 approved for bedridden or non-ambulatory residents, Room 5-approved for ambulatory ONLY. Building 2-Rooms 1-12 approved for bedridden or non-ambulatory. During today's visit, LPA inspected 6 bedrooms in Building 1, which currently has 5 residents, all exit doors/sliding glass doors are equipped with auditory alarms. LPA inspected Building #2, to include all 12 bedrooms. All 12 bedrooms had a bed, dresser, chair, and space for personal belongings and functioning lights. All 12 bedroom exit doors/sliding doors are equipped with auditory alarms. All 12 bedroom auditory alarms functioned properly when tested by the Licensee and ADM. Building 2 does not currently have any residents. Licensee and ADM were advised the facility cannot accept residents until the Department has processed all documentation for the capacity increase. Licensee and ADM stated understanding. No deficiencies cited during today's visit per California Code of Regulations, Title 22. An exit interview was conducted with ADM Minerva Velasco and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection visit, and met with Staff Minerva Velasco. Administrator (ADM) Jospehine Arcilla was not at the facility during inspection. During the visit, LPA observed 3 residents and 2 staff. LPA toured the facility with Staff to include the living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms, front yard and backyard. All exits and passageways were free and clear of obstruction. While touring the facility, Staff informed LPA that buildings 2 and 3 were still under construction. Staff stated all 3 residents are staying in building 1. LPA advised facility to inform the Department once the construction is complete in building 2 and 3. LPA toured the kitchen and observed a two day perishable food supply and seven day nonperishable food supply. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 74 degrees F, and hot water temperature was measured with a range of 109.4 to 116.2 F in 2 resident bathrooms. The facility was equipped with smoke and carbon monoxide detectors and were last inspected on 12/10/2024. Fire extinguishers were last serviced on 9/17/2024. LPA reviewed the facility first aid kit. The facility emergency drill log was reviewed. The facility's last drill was on 2/11/2025. LPA reviewed facility records for 3 staff and 4 residents. LPA reviewed 3 resident medications and centrally stored medication record. No deficiencies cited during today's visit. A Technical Assisted was provided seeLIC9102. This report was reviewed with Staff Minerva Velsaco and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Jesus Arcilla. During the visit, LPA observed 5 residents and 2 staff. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring the facility, ADM informed LPA that building 2 and 3 are under construction. ADM stated all 5 residents are staying in building 1. ADM stated once the construction is complete in building 2 and 3, he would inform Community Care Licensing. LPA requested a copy of the facility's fire clearance and a copy of the permits for building 2 & 3. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 72 degrees F, and hot water temperature was measured at 116 degrees F in both resident bathrooms. Fire extinguisher was serviced in September 20, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on January 23, 2024. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff (S1 and ADM) and 2 residents (R1-R2). No deficiencies cited during today's visit. This report was reviewed with Administrator Josephine Arcilla and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Mar 5, 2024