Melrose 48

Allegation investigated: Residents were left without staff supervision

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to initiate an investigation and deliver 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 September 20, 2026 the Department received this complaint which alleged residents were left without staff supervision. The Department’s investigation included a facility tour as well as interviews with staff and outside sources. (Continued on LIC9099-C) Substantiated (Continued from LIC9099) The facility is located on a multi-use property which includes four other licensed facilities. While LPA was at a facility next door to Melrose 48, LPA observed Staff #1 (S1) exit Melrose 48 and come into the facility LPA was at. LPA observed S1 grab plates and go back to Melrose 48. LPA followed S1 to Melrose 48 and observed there were no other staff in the facility. During the time S1 was at the facility next door, the residents had absence of supervision. Later, LPA again observed S1 exit Melrose 48 and enter the facility next door. S1 came to talk to the caregiver for about four minutes. LPA followed S1 back to Melrose 48 and again observed no other staff at the facility, resulting in the residents having no staff supervision during that time. An interview with an Outside Source (OS1) reported that they had observed the residents in care with an absence of supervision on one occasion. OS1 reported it was a time frame of at least 10 minutes but could have been longer as there were no facility staff at the facility when she initially arrived. The Department has investigated the allegation that residents were left without staff supervision. 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 809-D page) including a Civil Penalty totaling $500 (refer to LIC 421IM). 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 Rights (LIC9058) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 22, 2026 · control 08-AS-20260920151241

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Oct 2, 2026

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidenced by: Per LPA observation and interview with outside source, residents in the facility were without facility staff supervision. This poses an immediate health and safety risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Sep 22, 2026

Plan of correction: Administrator agreed to have a staff training regarding supervision and submit proof of training to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced Case Management visit to cite deficiencies identified during a separate complaint investigation. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Justin Mendoza. 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 conducted a resident record review which revealed that Resident #1 (R1) receives bed repositioning assistance from facility staff. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] Per the Medical Assessment form (LIC602A), for the purpose of a fire clearance bedridden is defines as a "resident who requires assistance with turning or repositioning in bed". Therefore, the facility is in violation of their current licensing limitations. Additionally, R1 receives home health care from an outside agency, but there is not a home health written agreement or any additional home health records in R1's file. Two deficiencies were observed and are being cited during todays visit per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages), including a Civil Penalty totaling $500 (refer to LIC 421IM). 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 809-D, LIC 421IM, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Aug 18, 2026

87202 Fire Clearance (a) All facilities shall maintain a fire clearance...Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall...obtain an appropriate fire clearance...(2)Bedridden persons This requirement was not met as evidenced by: Per records reviewed, the licensee does not have an approved fire clearance for bedridden residents and records reviewed revealed R1 requires repositioning assistance. This poses an immediate health and safety risk to 1 of 5 residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Administrator will submit a change of capacity form requesting for bedridden fire clearance by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87609(b)(4) · Plan of correction due date: Aug 21, 2026

87606 Allowable Health Conditions and the Use of Home Health Agencies (b)Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). This requirement was not met as evidenced by: Per records reviewed, licensee did not have home health records on file for R1. This poses a potential health and safety risk to 1 of 5 residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Administrator will provide LPA with home health written agreement by POC due date.

Allegation investigated: Staff are not maintaining facility bedrooms in good repair Staff are not maintaining facility bedrooms in a clean condition Staff do not have the required training Staff are not able to communicate with resident

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to initiate and 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 July 24, 2026 the Department received this complaint which alleged staff are not maintaining facility bedrooms in good repair, staff are not maintaining facility bedrooms in a clean condition, staff do not have the required training, and staff are not able to communicate with Resident #1 (R1). [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] The Department’s investigation included a facility tour, record reviews, as well as interviews with residents, staff, and an outside source. (Continued on LIC9099-C) Unsubstantiated (Continued from LIC9099) Regarding the allegation that staff are not maintaining facility bedrooms in good repair, during unannounced facility visits LPA observed the facility to be clean, sanitary, and in good repair. Interviews with residents did not report concerns regarding the repair of their bedrooms. Additionally, LPA conducted an annual inspection of the facility on 7/20/26 and did not note any physical plant concerns. Regarding the allegation that staff are not maintaining facility bedrooms in a clean condition, during unannounced facility visits LPA observed bedrooms to be clean and sanitary. LPA interviewed an Outside Source (OS1) who reported concerns regarding cobwebs and tables being dirty. LPA did not observe these concerns. Interviews with residents did not report cleanliness concerns of their bedrooms. Interviews with staff reported cleaning the bedrooms regularly. Regarding the allegation that staff do not have the required training, LPA reviewed personnel records which revealed that staff had up to date required annual training and current CPR/first aid training. Regarding the allegation that staff are not able to communicate with R1, according to an interview with OS1, R1 speaks and understands English and Spanish but Spanish is preferred. LPA interview with Administrator reported that none of the staff speak Spanish fluent Spanish, but they are trying to hire a Spanish speaking caregiver. LPA interviewed R1 who demonstrated understanding English and stated they can communicate their care needs in English with staff. Interviews with facility staff reported they are able to understand and communicate with R1 in addressing their daily care needs. 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 at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 29, 2026 · control 08-AS-20260724102851

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 Rolly Laron. 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, laundry, 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 page). 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

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 0 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 single story structure with 7 bedrooms and 4 bathrooms, 3 of which will be used for resident and 1 staff. There is an outdoor covered area for resident use. No bodies of water were observed. Bedrooms Residents- Rooms #1, #2, #3, #4, #5 and #6 for Non-Ambulatory one (1) for staff Bedrooms Staff- staff are using Room #7 Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. The bathroom next door to the room is used only by staff. Linens & Hygiene Supplies- Adequate supply. Emergency Phone Numbers, Exit Plan and Required Postings- Posted. Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired. Appliances- Stove burners, oven, microwave, washer, and dryer working. Toxins- Stored in a locked cabinet. Water Temperature- Measured at 105- 109.4 degrees F. Medications- Centrally stored and locked in a cabinet. First-Aid Kit- Stored in a locked cabinet. Resident & Staff Files- Located cabinet. Activities- Adequate supplies to include games 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 signature below confirms receipt of these rights.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 no residents at this facility. LPA Holmes spoke with staff. 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’s representative, Justin Mendoza, Administrator. During today’s visit, LPA, accompanied by the applicant’s 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 representative, 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