Melrose 36

Allegation investigated: Staff neglect resulting in resident death Washing machine was not maintained in good repair Poor food quality provided to residents

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegations. LPA identified herself, explained the purpose of the visit and nature of the complaint to Administrator Justin Mendoza. On May 18, 2026 the Department received this complaint which alleged staff neglect resulted in resident death, washing machine was not maintained in good repair, and poor food quality was provided to residents. The Department’s investigation included a facility tour, record reviews, and interviews with staff. (Continued on LIC9099-C) Unsubstantiated (Continued from LIC9099) Regarding the allegation that staff neglect resulted in resident death, the Reporting Party specified neglect resulted in death for Resident #1 (R1) and Resident #2 (R2). Per the Certificate of Death, R1's cause of death was acute hypoxic respiratory failure and unspecified pneumonia. R1 passed away at a hospital on 11/23/25. There are no records indicative that R1’s cause of death was a result of staff neglect. Per R2’s hospice records, R2 passed away at the facility on 9/5/25 due to cardiac arrest. There are no hospice notes indicative that R2’s cause of death was a result of staff neglect. Regarding the allegation that the washing machine was not maintained in good repair, during unannounced visits LPA observed washing machines to be operable and in good repair. The facility sits on a property where there are five sister facilities. The laundry is centralized in Melrose 48 where there are two sets of washing machines and dryers and Melrose 30 where there is another washer and dryer set. Regarding the allegation that poor food quality was being provided to residents, during unannounced visits LPA observed meals served to residents to be well balanced and of good quality. LPA did not observe any food in the fridge or pantry to be expired or observe any reason that the food could not be served to residents. The Department has investigated the above mentioned allegations. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated. An exit interview was conducted with Administrator Justin Mendoza, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.the state’s words, verbatim · CDSS document, Aug 31, 2026 · control 08-AS-20260518141157

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced Case Management visit to cite a deficiency identified during a separate complaint investigation. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Justin Mendoza. During a review of resident records, it was revealed that Resident #1 (R1) had a hospital visit due to a fall. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] However, an internal review revealed that there was not an Incident Report submitted regarding R1’s fall per reporting requirements. One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A plan of correction was jointly developed with the Administrator. An exit interview was conducted with Administrator Justin Mendoza to whom a copy of this report and the Licensee/Appeal Right (LIC9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 31, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Sep 10, 2026

Reporting Requirements (a) Each licensee shall furnish to the licensing agency... (1) A written report...within seven days of the occurrence...(D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met by: Per records reviewed, the licensee did not submit a written report regarding an incident that resulted in R1's hospitalization. This posed a potential health and safety risk to 1 of _ residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2026

Plan of correction: Administrator agreed to review the regulations for reporting requirements and submit proof of review to LPA by POC due date.

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 greeted by, identified herself to, and discussed the purpose of the visit with Caregiver Allen Aganon. Administrator Justin Mendoza later 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 residents may be non-ambulatory, and there is a hospice waiver granted for 6. LPA, accompanied by caregiver, 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, visitation, meetings, and resident activities. 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 multiple staff and resident records. Resident records reviewed did not contain the required documentation. Confidential records were stored in locked areas. Proof of current/active business liability insurance was presented. One deficiency was observed and cited during todays visit per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages). A plan of correction was jointly developed with Administrator Justin Mendoza. An exit interview was conducted with Administrator Justin Mendoza, 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, Jul 20, 2026

Allegation investigated: Licensee did not ensure person with access to clients received a criminal record clearance.

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to Administrator Justin Mendoza. On June 22, 2026 the Department received this complaint which alleged the Licensee did not ensure person with access to clients received a criminal record clearance. The Department’s investigation included, record reviews, as well as interviews with staff, residents, and an outside source. (Continued on LIC9099-C) Substantiated (Continued from LIC9099) According to Outside Source #1 (OS1) they were employed by the facility to do maintenance and while employed lived on the facility premises. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] OS1 reported never completing a background check while working at the facility. OS1 reported they are no longer employed by the facility and no longer live on the property. Interviews with facility staff corroborated OS1 being at the facility and performing various maintenance and landscaping duties inside and outside the facility. An interview with a resident also reported OS1 was at the facility fixing things on a regular basis. All interviews confirmed OS1 is no longer at the facility. Per records reviewed, OS1 was never associated with the facility profile through the Department’s Guardian Background Check website, nor did the facility have any record of OS1 being fingerprinted cleared. The Department has investigated this allegation and based upon the information obtained during this investigation, it is determined that the preponderance of evidence was met to support this allegation and therefore deemed substantiated. One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page) and a Civil Penalty was assessed for a total of $500 (refer to attached LIC 421BG). A Plan of Correction was jointly developed with the Administrator. An exit interview was conducted with Administrator Justin Mendoza, to whom a copy of this report, the LIC 9099-D, LIC 421BG, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 24, 2026 · control 08-AS-20260622173430

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80019(e)(2) · Plan of correction due date: Jun 24, 2026

Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance...as required by the Department... This requirement was not met as evidenced by: Per records reviewed and interviews, OS1 did not have criminal background clearance while working at the facility and residing on facility premise. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2026

Plan of correction: OS1 no longer resides/works at the facility, therefore the POC is satisfied.

Allegation investigated: Insufficient and Invalid Rate Increase Notice

Licensing Program Analyst (LPA) Correia conducted an unannounced visit to initiate a complaint investigation. LPA was greeted by Administrator (ADM) Mendoza, identified herself, and explained the purpose of the visit. On April 4, 2026, the Department received a complaint alleging that the facility issued a notice of change in monthly rate that did not meet the criteria outlined in State Mandate and the Health and Safety Code. During today’s visit, LPA conducted interviews with facility staff and outside sources and obtained pertinent records. A review of the facility’s notification regarding the monthly rate increase revealed that the change was scheduled to take effect 89 days from the date of the letter. Substantiated [Continuation of [LIC 9099] Based on a facility/resident records reviews and interviews with staff and outside sources the allegation was determined to be substantiated. An exit interview was conducted with Administrator Mendoza, to whom a copy of this report (LIC 9099), the deficiency page (LIC D 9099D), and Licensee Appeal rights (LIC 9058) were provided at the conclusion of today's visit.the state’s words, verbatim · CDSS document, Apr 29, 2026 · control 08-AS-20260410143701

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Apr 23, 2026

Increase...rates for elderly...; 90 days’ written notice...reasons...(a) a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase and the reason or reasons for the increase... description... costs, except for...rate due to a change in the level of care... This requirement was not met as evidenced by: Based on a review of Resident 1 [R1] notification letter of rate increase was less than a 90 day notice prior to the effective date.the state’s words, verbatim · CDSS document, Apr 29, 2026

Plan of correction: Administrator will reissue a new 90-day notice of the monthly rate increase by the POC due date. Administrator provided proof of correction (copy of the resubmitted notice of rate increase) dated 4/23/2026.

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 4 COMP II Participants: Melanie Tena, Managing Member, Justin Mendoza, Administrator Interview Method: Telephone interview On 1/30/26, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Tiffany Holmes conducted an announced Pre-licensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 10/10/2024. The facility was approved to care for six (6) Elderly Residents; six (6) Non-Ambulatory and six (6) hospice. LPA was greeted and allowed entry into the facility by and met with Arceli Songco, Administrator. Structure- The facility is a double story structure with 6 bedrooms and 4 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents- Rooms #1, #2, #3, #4, #5 & #6 for Non-Ambulatory use. Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies- Adequate supply. Emergency Phone Numbers, Exit Plan and Required Postings- Posted. Smoke Detectors and Carbon Monoxide Detectors- working. Appliances- Stove burners, oven, microwave, washer, and dryer working. Toxins- Stored in a locked cabinet. Water Temperature- Measured at 109 degrees F. Medications- Centrally stored and locked in a cabinet in the kitchen. First-Aid Kit- Stored in a locked cabinet. Resident & Staff Files- Located in the cabinet. Activities- Adequate supplies to include exercising, painting, and puzzles for resident's use. Fire clearance- Approved on 12/13/24. Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Pre-licensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Arceli Songco, Administrator, their signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Mar 25, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tiffany Holmes conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified themselves to, and explained the purpose of the visit to the applicant’s representative, Arceli Songco, Administrator. During today’s visit, LPA, accompanied by the applicant’s representatives, toured the interior and exterior of the facility and inspected each room. There are items which must be corrected for the facility to comply with regulations. The applicant did not pass the pre-licensing inspection, and a return visit will be required. An exit interview was conducted with the applicant’s representative, Arceli Songco, Administrator 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, Mar 12, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Justin Mendoza, Administrator. LPA briefly toured the facility, performed a health and safety welfare check. There are four (4) residents at this facility. LPA Holmes spoke with staff and residents. No deficiencies were observed or cited on this date. An exit interview was conducted with Justin Mendoza, Administrator, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 6, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tiffany Holmes conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified themselves to, and explained the purpose of the visit to the applicant representative, Justin Mendoza, Administrator. During today’s visit, LPA, accompanied by the applicant representative, toured the interior and exterior of the facility and inspected each room. There are items which must be corrected for the facility to comply with regulations. The applicant did not pass the pre-licensing inspection, and a return visit will be required. An exit interview was conducted with the applicant’s representatives, 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, Feb 6, 2025