Mainline Home Care

Type of visit: Required - 1 Year

On 05/21/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with care staff, Nora Pambago, and explained the purpose of the visit. Care staff Pambago then contacted Administrator Ma Magnolia M. Tolon to inform her that Community Care Licensing Division (CCLD) staff were present at the facility. Approximately 30 minutes later, both Licensee Aida Gatchalian and Administrator Tolon arrived and assisted with the visit. Administrator Tolon holds Administrator Certificate #7019084740, which expires on 05/05/2027. The facility census was six (6) residents, with two (2) staff present during the visit. This facility is a single story building licensed to serve six (6) non-ambulatory residents with one bedridden resident and hospice waiver approved for three (3) residents. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, garage, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. The linen closet was inspected and observed to contain a sufficient supply of linens for the six residents in care. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 112.5 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. The smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen and was last serviced on 02/27/2026. The last fire drill was conducted on 04/10/2026. LPA Lee observed the facility has a has a public telephone in the kitchen and the facility has the required posters posted. CONTINUED LIC 809-C Facility thermostat was observed at 75 degrees Fahrenheit, which is within the required regulation of 68 to 85 degrees Fahrenheit. LPA Lee observed toxins located in a locked cabinet stored in the garage and inaccessible to residents. LPA Lee observed sharp knives kept locked in the kitchen cabinet and inaccessible to residents. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. The first aid kit was checked and contained the required components. LPA Lee audited medications for 3 out of 6 residents by comparing the medications on hand with their Medication Administration Records (MARs) and confirmed that all records were accurate and complete. LPA Lee reviewed 6 out of 6 resident files, and they were complete. LPA Lee reviewed 2 staff files, and it was also complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated with the facility. The following documents were provided to LPA Lee during today’s visit: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Administrator Tolon and Licensee Gatchaliana and a copy of these LIC 809 reports was provided to the facility.the state’s words, verbatim · CDSS document, May 21, 2026

Type of visit: Required - 1 Year

On 4/22/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced at this facility to conduct their annual inspection visit. LPA initially met with staff on duty and explained the purpose of this visit. Staff then notified the administrator, Ma. Magnolia Tolon, and both the licensee and administrator arrived shortly after. Present today visit were 5 residents in care with 2 staff on duty. This facility has an approved hospice waiver for (3) residents at any given time. This facility also has, on file, a program to accept and retain residents diagnosed with dementia at this time. Administrator certificate was observed to be present and in compliance at this time. A tour of this facility was conducted. Facility is a one-story home located in a residential neighborhood. Kitchen area was toured. Cabinets and drawers were inspected. Food preparation stations, dishwashing station, and other areas intended for meal preps were also inspected. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the hallway was inspected. The medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of 5 of 6 resident bedrooms and 2 of 3 restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperature was taken in 1 of 2 bathroom and measured at 117 degrees Fahrenheit. Room temperature during this visit was measured at 74 degrees Fahrenheit. {1 of 2} Linen closet, located in the resident hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 3/5/25. Facility conducts quarterly emergency drills. Last drill was conducted on 4/1/25. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted and found to be in good repair at this time. A review of (3) facility resident files was conducted and noted on the following LIC 858. 1 of 3 resident did not have PRN authorization on file. Advisory was provided for resident to obtain one. Per discussion with the administrator, she will obtain one from resident doctor. LPA conducted a medication review of 3 residents. In one resident review, LPA observed one medication (M1) was prescribed with the dosage of 1mg (1000mcg); but facility has 800mcg on hand. A review of (3) facility personnel files was conducted and noted on the following LIC 859. 3 of 3 staff reviewed are associated to this facility. and 2 of 3 staff have current 1st aid/CPR certificate. 1 of 2 staff member on duty did not have a current first aid certification. During the discussion, the staff member believed that first aid was included in the certification. The following forms and documents were obtained during this visit: LIC 308 - Designation of administrative responsibility LIC 409 - Administration organization LIC 500 - Personnel report LIC 610E - Emergency Disaster Plan Deficiencies were observed from today's visit. Exit interview was conducted and a copy of this report was provided. {2 of 2}the state’s words, verbatim · CDSS document, Apr 22, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

On 10/15/24, at 9:30am, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to this facility to conduct a case management visit. LPA initially met with one of the staff on duty (S1) and stated the purpose of the visit. The Licensee, Aida Gatchalian, was notified of this visit and arrived shortly after. Present during today's visit were 6 residents in care with 2 staff on duty (S1 and S2). During this visit, LPA Villanueva conducted an inspection of the facility, which included the living room, family room, bathroom, kitchen/dining area, bedrooms, and garage. In the family room, three residents were observed watching TV. While inspecting one of the bathrooms, LPA observed a spray cleaning bottle on the toilet seat and a cleaning solution on the floor, for which a photo was taken. At that time, S1 was assisting a resident in the dining area, while S2 was aiding another resident in their bedroom. The facility features a three-car garage, which was inspected. The right side of the garage was sectioned off with cabinets, which contained clothing belonging to the owner, as confirmed by S1. In this area, LPA also observed four mattresses propped upright against the wall, along with luggage and boxes. Near the exit door leading outside, a lounge chair and a shoe organizer filled with shoes were noted. Additionally, the garage contained refrigerators and various food supplies. The left side of the garage has couches which is covered with white sheet and boxes of incontinent supplies. While inspecting the kitchen refrigerator, LPA found three bottles of medication (M1) placed in a plastic Ziploc bag labeled with a resident's name on the left door storage shelf. On the right door's top shelf, another medication (M2) belonging to a different resident was observed, along with a medication (M3) that belonged to the Licensee. {1 of 2} Interviews were conducted with S1 and the Licensee during the visit. Both confirmed that no staff members are using the garage as a bedroom. The Licensee indicated they work the night shift from 7 AM to 7 PM to provide overnight supervision, emphasizing that they do not have live-in staff. Further interviews clarified that the mattresses stored in the garage belonged to residents prior to them acquiring hospital beds. The couches that were previously in the family room have been relocated to the garage, as residents now have their own reclining chairs. During the discussion with the Licensee, they expressed their commitment to cleaning and organizing the garage to ensure it does not appear to be used other than as a garage. The Licensee assured LPA that they would inform the Department in advance if they ever decide to convert the area into a room or an office. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. During the exit interview conducted with Aida Gatchalian, LPA read this report and discussed deficiencies and plan of corrections and and a copy of this report and appeal rights were provided. {2 of 2}the state’s words, verbatim · CDSS document, Oct 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Oct 16, 2024

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, licensee did not comply with the regulation noted above. It was observed that 3 medications were stored in the kitchen refrigerator. This poses an immediate health and safetythe state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee to submit a written statement of understanding of the regulation cited and submit statement to the Department by POC due date. Per discussion with Licensee, they have agreed to provide staff training on proper medication storage. Licensee will submit completed training by end of day on 10/25/24. Per Licensee they will obtain a locked box and will store the locked box in the garage refrigerator.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(f)(2) · Plan of correction due date: Oct 16, 2024

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation, licensee did not comply with the regulation noted above. During inspection of one bathroom, LPA observed cleaning supplies on the floor and on top of the toilet seat cover. This poses an immediate health and safetythe state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee to submit a written statement of understanding of the regulation cited and submit statement to the Department by POC due date. Per discussion with Licensee, they have agreed to provide staff training on proper storage of dangerous items and chemicals. Licensee will submit completed training by end of day on 10/25/24.

Type of visit: Case Management - Annual Continuation

On 5/14/24, at 9:35am, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this facility unannounced to conduct an annual continuation visit. The purpose of this visit is to continue the required annual inspection initiated on 4/22/24. LPA initially met with one of the staff on duty and explained the purpose of the visit. The administrator, Maria Magnolia Tolon, was notified of the visit and arrived shortly after along with the licensee, Aida Gatchlian. Present during this visit were 4 residents in care with 2 staff on duty. Note that prior to this visit, a fire inspection was initiated to obtain a fire clearance for the room marked as "staff room" on the facility sketch as resident bedroom. This room is not fire cleared for resident use at this time. Per interview with administrator and licensee, the fire marshal visited on 4/23/24 and suggested to install a ramp for the exit door of this room and will revisit the facility once the Department submit form STD 850 and the installation of the ramp has been completed. LPA Villanueva submitted the form on 5/3/24 to the Consumnes CSD Fire Department. Per today's observation, a fire door has been installed in this bedroom. During this inspection, LPA conducted an audit of facility files, 5 resident files, and 3 staff files for regulatory compliance. All staff files reviewed contained required contents including health screening, TB results, current first aid/CPR, and initial and ongoing required training and are associated to this facility. 5 of 5 resident files reviewed contain updated Physician Report and Needs and Services Plan. Additionally, resident files contain at least the following: Admission Agreement, Centrally Stored Medication Records, Weight Records, Emergency Information, and Consent Forms. LPA discovered 1 of 5 residents' medical assessment was signed by a Nurse Practitioner (NP). A technical advisory was provided to obtain a waiver request from the Department. LPA also reviewed resident medications for regulatory compliance. No issues were noted at this time. LPA conducted staff and resident interviews. Facility’s liability insurance is current per regulatory requirements. LPA reviewed facility’s disaster plan to ensure regulatory compliance. LPA observed that facility conducts quarterly fire drills. Last drill conducted was on 4/5/24. LPA was provided current copy of facility's LIC 308, LIC 500, and liability insurance. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. An exit interview was conducted with Aida Gatchalian and Maria Magnolia Tolon, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 14, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(1) · Plan of correction due date: May 15, 2024

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal... (1) Nonambulatory persons. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the regulation noted above. It was discovered that the room fire cleared as "staff" room on the facility sketch is being used as a resident room by non-ambulatory resident during this visit. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 14, 2024

Plan of correction: LPA submitted form STD 850 to the local fire department on 5/3/24. Local fire marshal conducted an initial visit and suggested for an installation of a ramp at the exit door. Licensee to install a ramp at the exit door of the said bedroom and will send photo evidence to the Department once completed. Licensee to submit a written statement of understanding of the regulation CCR 87202 to the Department by POC due date.

Type of visit: Required - 1 Year

On 4/22/24 at 3:45pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this facility unannounced to conduct the required annual inspection. LPA initially met with a staff on duty and explained the purpose of the visit. The administrators, Aida Gatchalian and Ma Magnolia Tolon, were notified and arrived shortly after. Present during today's visit, there were 4 resident in care with 2 staff on duty. Two residents were out in the community. The facility is approved to retain/accept 3 hospice residents. The facility is fire cleared for 5 non-ambulatory residents and 1 bedridden resident (bedroom #4 on the facility sketch). At 3:50pm, LPA and Ma Magnolia toured the physical plant of the facility. The facility is a one-story house located in a residential neighborhood. The room temperature was observed to be at 72 degrees F. LPA inspected the kitchen area. The kitchen was observed to be clean, sanitary and odorless. Inside the food pantry was observed to be fully stocked with only food and observed to be clean and free of vermin and insects. Kitchen refrigerator was observed to be at 40 degrees F. and kitchen freezer was observed to be at 0 degrees F. Sharp objects such as knives were observed to be locked and inaccessible to residents in care. The facility maintain a 2 day perishable food and 7 day non-perishable food. Additional food were observed in the additional refrigerators and freezers in the garage area. Technical advisory was provided to obtain and place thermometers in the freezers and refrigerators in the garage to monitor and ensure regulatory temperatures are maintained. LPA observed 3 fire extinguishers and were last served on 3/5/24. LPA observed the laundry room to be equipped with washer and dryer and laundry detergents and other supplies were observed to be locked. The facility maintain an adequate supplies of linen, extra beddings, bath towels and wash clothes for resident use. LPA observed porches and hallways to be unobstructed. Fireplace was observed to be screened and not in used. Medications were observed to be centrally stored, locked and inaccessible to residents in care. LPA observed bedrooms to have adequate space and fully furnished. It was observed that the bedroom marked as "staff room" on the facility sketch is now being utilized as a resident bedroom. Interview with Aida and Ma Magnolia, confirmed that one of the resident in care is currently using that room as their bedroom. Outside the facility, LPA observed a covered porch equipped with outdoor furniture for outdoor activities. Per interview and observation, the fence on the right side of the house has been replaced. LPA observed the backyard and front yard to be free of obstruction and debris. Due to time constraint, LPA Villanueva will return to this facility to complete this annual visit. An exit interview was held with Aida Gatchalian and Ma Magnolia Tolon and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 22, 2024

Type of visit: Case Management - Other

On 3/5/2024, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to conduct a case management visit. LPA initially met with a staff on duty and explained the purpose of the visit. The facility administrators, Aida Gatchalian and Ma Magnolia Tolon, were notified of this visit and arrived shortly after. Present during this visit are 3 residents in care with 2 staff on duty. The purpose of this visit was to follow up on an exception request regarding Resident 1(R1). LPA reviewed R1's facility file including but not limited to Pre-Appraisal, Needs and Services Plan and Physician's Report. It was learned through record review and interviews that the resident has been using indwelling Foley catheter continuously since November 2023 without an exception request. The needs and services plan dated on 3/20/2023 states that R1 is on and off on the use of Foley catheter. In addition, a review of the resident's home health notes indicates that R1 has been seen for routine catheter changes since 11/1/23 and R1 gets routine catheter changes every 4 weeks. Based on interviews conducted, it was learned that the resident does not clean their catheter and needs staff assistance at this time. Aida and Ma Magnolia stated that they were not aware that an exception request was needed to be sent to the department for the use of catheter. Based on the information gathered during the course of this visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, the following deficiencies are being cited today in violation of California Code of Regulations. An exit interview was conducted with Aida and Ma Magnolia and a copy of this report and appeals rights were provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Mar 5, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87611(a) · Plan of correction due date: Mar 6, 2024

87616 Exceptions for Health Conditions: (a) ... the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. This is not met as evidenced by: Based on interviews and record review the Licensee did not ensure that a written request for an exception was sent to the Department for approval as soon as R1 started using a catheter. This poses an immediate, health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 5, 2024

Plan of correction: Licensee has already submitted an exception request for catheter to the Department and awaiting for Department approval. Licensee to submit a statement of understanding of the regulation related to restricted/prohibited health conditions to the Department by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(d)(2) · Plan of correction due date: Mar 12, 2024

(d) The administrator shall have... (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This is not met as evidenced by: Based on interview and record review, the licensee did not ensure that the facility obtained an exception request for R1's indwelling catheter as soon as R1 started using catheter.the state’s words, verbatim · CDSS document, Mar 5, 2024

Plan of correction: The licensee shall provide a statement of understanding regarding the following regulation 87405(d)(2) to the Department by the POC date.