Mayflower Guest Home II

Type of visit: Required - 1 Year

On 02/02/2026, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Singh met with a staff and was granted entry to the facility. Facility Licensee Atanacio C. Fajardo and Administrator Cristina Fajardo arrived during the visit. At the time of the visit there were Eleven (11) residents and four (4) staff present. Staff informed LPA Singh that two(2) residents were out in the community. On 9/29/2025, LPAs Singh and Guerrero conducted a case management visit. While conducting an inspection of the facility LPAs observed termites dropping on the bed in bedroom #4 with one resident is currently occupying the room, this poses a potential health and safety risk for clients in care. While continuing the inspection LPAs inspected first restroom located on the first-floor to have mold on the ceiling, through the walls and inside the bathroom cabinets. Due to mold one bedroom#4 and a bathroom are locked and Riverside county will be do the construction on the property soon. Resident has been moved to another room due to health and safety risk. The facility is an eleven (11) bedroom, and four (4) bathroom home with a kitchen/dining area, living room/activity room. currently one bedroom room #4 and a bathroom are locked due to mold issues. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of fifteen (15) ambulatory residents and the current census is Thirteen (13) residents. LPA Singh was accompanied by Administrator Fajardo 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 Division (CCLD). There are no obstructions to indoor and outdoor passageway. The facility is maintained at a comfortable temperature. LPA Singh inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night-stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Singh observed the water temperature in the bathrooms to be within the regulations. The facility is equipped with operating smoke detectors and carbon monoxide alarms. There were five (5) fire extinguishers observed at the facility. Posters such as labor laws, and the disaster plan were posted in a common area, but LPA Singh observed the personal rights, the CCLD complaint poster and Ombudsman poster were posted in a common area. Cleaning supplies, chemicals and other dangerous items were locked, not accessible to residents. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPA Singh observed a complete first aid kit and first aid book at the facility. Food Service: More than seven (7) days’ supply of non-perishable foods and more than three (3) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has an Administrator present in the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Singh reviewed six (6) resident files for admission agreements, physician reports, pre-placement appraisals, functional capabilities and needs and services plans. LPA Singh observed there were required pre-placement appraisals, functional capabilities and needs and services plan documentation on file. LPA Singh reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. LPA Singh audited three (3) residents medications were audited and per review of their Medication Administration Record (MAR) was updated. Fire/Earthquake drill was conducted on November 17, 2025. Liabiliy Insurance valid through 7/8/2025 to 7/8/2026. 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), LIC809C were discussed and provided to Administrator Cristina Fajardo.the state’s words, verbatim · CDSS document, Feb 2, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Beena Singh and LPA Paola Guerrero made an unannounced visit to the facility. LPAs conduct the joint visit with Paxton Jackson, Facilities Project Planner (CCE) County of Riverside, Department of Public Social Services. (DPSS). LPAs arrived at the facility to conduct a case management visit to inspect the facility regarding mold and termite issues. LPA met with facility Administrator Cristina Fajardo and explained the purpose of today's visit. The facility is an eleven (11) bedroom, and four (4) bathroom home with a kitchen/dining area, living room/activity room. The facility is the Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of fifteen (15) ambulatory residents and the current census is Thirteen (13) residents. LPA Singh was accompanied by Administrator Fajardo 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 Division (CCLD). While conducting an inspection of the facility LPAs observed termites dropping on the bed in bedroom #4 with one resident is currently occupying the room, this poses a potential health and safety risk for clients in care. While continuing the inspection LPAs inspected first restroom located on the first-floor to have mold on the ceiling, through the walls and inside the bathroom cabinets, LPAs observed personal care products and other hygiene items were being stored and exposed to mold, deficiencies will be issued. Based on the observations made during today’s visit, two deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D were discussed and provided to Administrator Cristina Fajardo.the state’s words, verbatim · CDSS document, Sep 29, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a)(1) · Plan of correction due date: Sep 29, 2025

87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. Based on observation, interview and record review, the licensee did not comply with the section cited above by not keeping termites free with a resident sleeping in the same room, which poses a health and safety risk and also a common downstairs restroom for the residents has mold on the ceiling and on the walls and cabinets,which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 29, 2025

Plan of correction: Licensee shall repair and or replace the shower walls and provide proof to Licensing that they were repaired.

From the deficiency page — Deficiency type: Type A · Section cited: HSC87468.1(a)(2) · Plan of correction due date: Sep 29, 2025

Personal Rights of Residents in All Facilities General....(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:....(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Based on interviews, and record review, the licensee did not ensure that facility resident are safe and protected from termites and mold in bedroom#4 and mold in downstairs bathroom, based on title 22 regulation, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 29, 2025

Plan of correction: Licensee shall repair and deal with mold issues and move resident#1 to another room as soon as possible and lock bathroom and bedroom with a sign on the doors "Out of service" until repaired. Licensee will send pictures of locked doors and sign and repair once done.

Type of visit: Required - 1 Year

On 03/12/2025 at M, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Singh met with Administrator Cristina Fajardo and was granted entry to the facility. At the time of the visit there were fifteen (11) residents and six (6) staff present. The facility is an eleven (11) bedroom, and four (4) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of fifteen (15) ambulatory residents and the current census is fifteen (11) residents. LPA Singh was accompanied by Administrator Fajardo 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 Division (CCLD). There are no obstructions to indoor and outdoor passageway. The facility is maintained at a comfortable temperature. LPA Singh inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night-stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Singh measured and observed the water temperature in the bathrooms to be at 108 degrees F and 110 degrees F in second bathroom. The facility is equipped with operating smoke detectors and carbon monoxide alarms. There were five (5) fire extinguishers observed at the facility. ***Continuation in LIC809C *** Posters such as labor laws, and the disaster plan were posted in a common area, but LPA Singh observed the personal rights, the CCLD complaint poster and Ombudsman poster were posted in a common area. Cleaning supplies, chemicals and other dangerous items were locked, not accessible to residents. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPA Singh observed a complete first aid kit and first aid book at the facility. Food Service: More than seven (7) days’ supply of non-perishable foods and more than three (3) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has an Administrator present in the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Singh reviewed three (3) resident files for admission agreements, physician reports, pre-placement appraisals, functional capabilities and needs and services plans. LPA Singh observed there were required pre-placement appraisals, functional capabilities and needs and services plan documentation on file. LPA Singh reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. LPA Singh audited three (3) residents medications were audited and per review of their Medication Administration Record (MAR) was updated. 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), LIC809C were discussed and provided to Administrator Cristina Fajardo.the state’s words, verbatim · CDSS document, Mar 12, 2025

Type of visit: Required - 1 Year

On 02/08/2023 at 09:30 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. Administrator Cristina Fajardo was contacted and arrived at the facility during the visit. At the time of the visit there were fifteen (15) residents and six (6) staff present. The facility is an eleven (11) bedroom, and four (4) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of fifteen (15) ambulatory residents and the current census is fifteen (15) residents. LPA Brown was accompanied by Administrator Fajardo 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 Division (CCLD). There are no obstructions to indoor passageway but LPA Brown observed obstructions to outdoor passageways as piles of wood were observed with visible nails hanging located at the backyard of the home. Deficiency will be issued. The facility is maintained at a comfortable temperature. LPA Brown 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. However, LPA Brown observed no reading lamps on Room # 4, Room #5, Room #2, Room #9 and Room #11. Also, LPA Brown observed no chairs in Room # 8, Room #9 and Room #10. Deficiency will be issued. LPA Brown measured and observed the water temperature in the bathroom to be at 108 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. ***Continuation in LIC809C *** Posters such as labor laws, and the disaster plan were posted in a common area, but LPA Brown observed the personal rights, the CCLD complaint poster and Ombudsman poster were not posted in a common area. Deficiency will be issued. Cleaning supplies, chemicals and other dangerous items were observed not locked at the back area of the facility, making it accessible to residents in care. Deficiency will be issued. Also, LPA Brown observed no activity schedule posted at the facility. Deficiency will be issued. Furthermore, LPA Brown observed no night lights and emergency lightning maintained at the facility. Deficiency will be issued. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPA Brown observed a complete first aid kit and first aid book at the facility. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than three (3) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has an Administrator present in the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Brown reviewed three (3) resident files for admission agreements, physician reports, pre-placement appraisals, functional capabilities and needs and services plans. LPA Brown observed that Resident #1 (R1), Resident #2 (R2) and Resident #3 (R3) do not have the required pre-placement appraisals, functional capabilities and needs and services plan. Deficiencies will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA Brown found that Staff #2 (S2), and Staff #5 (S5) do not have completed Health Screening report with Tuberculosis (TB) Result maintained in their facility file and no required annual trainings were completed by S2 and S5. Also, LPA Brown observed that S2 and S5 do not have the required contiunation/annual training maintained on S2 and S5 facility file and S5 does not have the required initial training. Deficiencies will be issued. Moreover, three (3) residents medications were audited and per review of their Medication Administration Record (MAR), LPA Brown observed two (2) medications for Resident # 1 (R1) were dispensed but R1's MAR was not updated and one (1) medication was dispensed for Resident #3 (R3) and R3’s MAR is not updated. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, LIC9102 and Appeal Rights were discussed and provided to Administrator Cristina Fajardo.the state’s words, verbatim · CDSS document, Feb 8, 2024

The state marks this report as 17 pages; the online copy we transcribed has 10. You can request the full file from the county licensing office.