Melvin Residential Care

Type of visit: Case Management - Other

At 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted a Case Management visit - CLOSURE and met with the Administrator. An entrance Interview was conducted. During the visit LPA was given a tour of the facility. LPA confirmed that there were no residents residing in the facility and that operation had ceased. The reason for closure of the facility is Licensee initiated due to the retirement of the Licensee and the Administrator. Administrator surrendered the License to LPA. LPA will submit the file for closure upon returning to the Woodland Hills South Regional Office. The Administrator was reminded that she is not to admit/retain any residents at the home who require care and supervision. Exit Interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Dec 15, 2025

Type of visit: Required - 1 Year

At 1:45 PM, Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff Gina Jamilano who granted access to the facility. The staff contacted the Administrator Rosalie Tabayoyong via telephone and LPA explained the purpose of the visit. The Administrator arrived shortly after. The facility is licensed to serve five (5) residents over the age of 60, of which five (5) may be non-ambulatory and has a hospice waiver approved for one (1). LPA OBSERVATIONS: The facility is a single-story located on a residential street and consists of three (3) resident bedrooms, one (1) bathroom, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA observed auditory devices on entry of door to be operational, sliding door and exits. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA observed knives and sharps located in kitchen cabinet, to be inaccessible to one (1) out of one (1) resident in care. LPA observed several Lysol disinfectant wipes and other cleaning solution sprays on the top of the kitchen sink and accessible to a one (1) out of one (1) resident in care. Kitchen appliances were observed to be clean and in working order. Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Nearby thermostat was observed to read 69-degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. Continue on LIC 809C Medications: At 1:55 PM, LPA observed medication being locked in the kitchen cabinet and were inaccessible. a locked office where all residents medications were locked and inaccessible. LPA also observed residents and staff files locked in the garage area and available for review. Bedrooms: LPA observed three (3) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. Bedroom #1 is private and bedrooms 2 & 3 are shared. Bathrooms: The facility has one (1) bathroom. The bathroom contained fully stocked soap, paper towels, trash can, non-skid mats, and grab bars. LPA observed trash cans with tight fitting lids, -Hot water temperature measured at 109.6°F. LPA observed that the bathroom sink is clogged. Garage: LPA observed emergency water and extra PPE/linens, and toiletry items in this area. Access to garage was observed to be inaccessible to one (1) out of one (1) resident in care. LPA also observed functional washer and dryer in the garage and inaccessible to residents in care. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Between 2:15 PM to 3:15 PM, LPA reviewed records of one (1) resident and one (1) staff. Resident and staff records appeared to be complete and updated. During the interview with one (1) out of one (1) resident, LPA was informed that the facility staff does not provide any milk to the resident without any Physician order. Administrator confirmed that the milk is being withheld from the resident without a Physician order. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. A deficiency was issued during today's visit. Appeal rights explained. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Apr 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required 1-year Visit on 05/18/2024. LPA was met by Administrators Rey Tabayoyong and Rosalie Tabayoyong and explained the purpose of the visit. The facility is licensed to serve five (5) residents over the age of 60, of which five (5) may be non-ambulatory and has a hospice waiver approved for one (1). LPA OBSERVATIONS: The facility is a two-story dwelling located on a residential street and consists of three (3) resident bedrooms, one (1) bathroom, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory devices on entry of door to be operational, sliding door and exits. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to one (1) out of one (1) resident in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located under kitchen sink, to be inaccessible to one (1) out of one (1) resident in care. Kitchen sink water temperature was measured at 116.5 degrees F. Kitchen appliances were observed to be clean and in working order. Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Nearby thermostat was observed to read 69-degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. SEE 809-C Resident Rooms 1-3: LPA Ramirez inspected three (3) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. Bedroom #1 is private and bedrooms 2 & 3 are shared. Bathrooms 1: Water temperature bathroom was within 105- 120 degrees F. Backyard: Was clean and well maintained. No hazards were observed. Plenty of shade and seating was observed. Garage: PA Ramirez observed emergency water and extra PPE/linens, and toiletry items in this area. Access to garage was observed to be inaccessible to one (1) out of one (1) resident in care. Emergency Drills/Emergency Disaster Plan/First Aid Kit: LPA Ramirez observed Emergency & Disaster Plan (LIC 610E) during inspection. Last fire drill was conducted on 04/20/24. LPA Ramirez observed a First Aid kit in kitchen cabinet. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for three (3) staff. LPA Ramirez observed Administrator’s certificate for Rosalie Tabayoyong with an expiration date of 11/24/2022. LPA Ramirez observed proof of submission for renewal of Administrator’s Certificate. LPA Ramirez will issue Technical Advisory. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel records reviewed. Resident Records: One (1) resident record was reviewed. Liability Insurance & Infection Control Plan: Facility will send proof of liability insurance within 7 calendar days. Facility will send infection control plan within 7 calendar days. LPA Ramirez will issue two (2) technical advisories. Exit interview was conducted. No deficiencies cited today. A copy of this report, LIC 9120 and appeals rights was provided.the state’s words, verbatim · CDSS document, May 18, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.