Pacaldo

Type of visit: Required - 1 Year

On May 19, 2026 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. Upon entry, LPA met with caregivers, Maria Razon and Eduard Caberto and LPA explained the purpose of the visit. The administrator, Oscar Madrigal arrived shortly thereafter and assisted with the inspection. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. The indoor and outdoor passageways were free of obstruction. The facility has 6 private rooms. Furniture and furnishings were observed to be sufficient. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Toilet, hand washing and bathing areas were observed clean and in operating condition. Facility exits are equipped with audible alarms. Comfortable temperature is maintained and lighting is sufficient for comfort Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. Central storage for medications, sharps and chemicals were observed to be locked and inaccessible to residents in care Hot water temperature in the kitchen and bathroom were measured at 108- 112 degrees Fahrenheit. Fire extinguishers were checked and last inspected on 4/17/2026. A review of (2) resident files was conducted and noted on the LIC 858. A review of (3) staff files was conducted and noted on the LIC 859. Civil penalty of $200 dollars is being assessed today as S1 and S2 who were not associated with the facility and $250 for repeat violation for 87305(a) that was cited on 5/21/2025. Based on the facility sketch, it indicated that there were 2 storage rooms that was divided by a wall on the 1st floor, however, during today visit, LPA observed 1 big room that was converted into a living space for 2 staff members consisted of a big bed, personal hygiene items, clothes, and the administrator stated that staff members stayed there when they were working at the facility. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. . This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, May 19, 2026

Type of visit: Case Management - Health Checks

On October 23, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management health and safety visit in relation to a relocation of a resident from another facility due to facility closure. LPA met with Assistant Administrator, Winnie Coronel and explained the purpose of the visit. On October 15, 2025, due to an emergency placement, Resident 1 (R1) was relocated to Pacaldo LLC. During the visit, LPA observed R1's room to be clean and equipped with all required furnishings. R1's personal belongings were present and in tact. Medications were all present and locked. LPA reviewed R1's file and it was signed and completed. At the time of the visit, the Assistant Administrator indicated that R1 was at his/her day program. LPA requested an updated copy of the resident roster to be submitted by 10/24/25. No citations are issued during the visit. Report is reviewed with Assistant Administrator, Winnie Coronel and a copy is provided.the state’s words, verbatim · CDSS document, Oct 23, 2025

Type of visit: Case Management - Other

On May 21, 2025, Licensing Program Analyst (LPA) Murial Han, Fire Inspector and Deputy Building Official conducted an unannounced Case Management visit to follow - up on an observation that was made during the annual inspection by LPA. LPA met with the caregiver, Genalyn Napo and LPA explained the purpose of today's visit. During the annual visit on May 12, 2025, LPA observed 2 rooms on the lower level did not match the facility sketch and according to staff, both rooms were occupied by staff members. Therefore, LPA contacted the San Mateo Fire Inspector for assistance. During today's visit, LPA, fire inspector and the deputy building official observed downstair level consisted of one staff room next to the garage that is occupied by 2 current staff members and another room that was not shown on the facility sketch consisted of mattresses, TV, toaster over, refrigerator, and other personal living items. According to the fire inspector and the building official, the room next to the garage can be used as living space for staff temporarily and the other room shall not be used as a living space, but it can be used as a storage room only. In addition, they will provide a plan for today's observation and work with the facility and CCL. The administrator arrived during the inspection, and LPA related the above observation. Deficient is cited under California Health and Safety Code on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. Report was discussed and reviewed with administrator. A copy of this report and the Appeal Rights is provided.the state’s words, verbatim · CDSS document, May 21, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: May 28, 2025

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by based on observation, record review and interview, one of the room on the lower level is not included on the facility sketch and accoridng to the facility staff, it was occuped by facility staff and the facility was not able to provide any documents to proof that it was permitted which posed a potential risk for residents in care.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: The administrator/licensee will provide a plan of correction including a revised facility sketch reflecting the current facility floor plan, remove all the furniture, living items, clothes, mattresses, the cabinet, etc.. and provide photos to proof that it was completed and a copy of the revised facility sketch to CCL by 5/28/2025.

Type of visit: POC

On May 21, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced Case Management - Plan Of Correction visit. LPA met with the administrator and explained the purpose of today's visit. During today's visit, LPA toured the facility and reviewed documentation. The following deficiencies , which were cited on 5/12/2025 are corrected: - 87458(a) and - 87458(c)(1)(A) Medical Assessment - 87309(a) Storage Space & Access - 87355(e)(3) Criminal Records Clearance - 1569.625(b)(15) Other Provisions - 87506(a) Resident Records - 87506(b)(15) Resident Records - 87456(a)(2) Evaluation of Suitability for Admission - 1569.695(c) Other Provisions - 87405(d)(1)(2)(3) Administrator- Qualifications & Duties The administrator will provide a copy of the plan of correction for the following deficiency by the end of today- 5/21/2025 - 87608(a)(3) Postural Supports No deficiency is cited today. This report is reviewed and discussed with the administrator; a copy of this report and Cleared POC letters were provided.the state’s words, verbatim · CDSS document, May 21, 2025

Type of visit: Required - 1 Year

On May 12, 2025 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregivers, Genalyn Napo and Elizabeth Macabales Esguerra and explained the purpose of the visit. The administrator, Oscar Madrigal and Licensee, Juliet Pacaldo arrived shortly thereafter and assisted with the inspection. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. The indoor and outdoor passageways were free of obstruction. The facility has 6 private rooms. Furniture and furnishings were observed to be sufficient. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Toilet, hand washing and bathing areas were observed clean and in operating condition. Facility exits are equipped with audible alarms. Comfortable temperature is maintained and lighting is sufficient for comfort Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. Central storage for medications, and chemicals were observed to be locked and inaccessible to residents in care; LPA observed sharps were stored in the kitchen on the dish rack not locked and accessible to residents in care. Hot water temperature in the kitchen and bathroom were measured at 108-110 degrees Fahrenheit. Fire extinguishers were checked and last inspected on 1/21/2025 A review of (2) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. Civil penalty of $200 dollars is being assessed today as S1 and S2 were not associated with the facility. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. . This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, May 12, 2025

Type of visit: Required - 1 Year

On May 15, 2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, wilmina Coronel and explained the purpose of the visit. The administrator, Oscar Madrigal arrived shortly thereafter and assisted with the rest of the inspection. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. The indoor and outdoor passageways were free of obstruction. The facility has 6 private rooms. Furniture and furnishings were observed to be sufficient. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Toilet, hand washing and bathing areas were observed clean and in operating condition. Showers were observed equipped with non-skid mats and grab bars. Facility exits are equipped with audible alarms. Comfortable temperature is maintained and lighting is sufficient for comfort Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. Central storage for medications, sharps and chemicals were observed to be locked and inaccessible to residents in care. Hot water temperature in the kitchen and bathroom were measured at 106-110 degrees Fahrenheit. Fire extinguishers were checked and last inspected on 9/28/2023. A review of (5) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. No deficiency is cited today; this report is reviewed and discussed with the administrator; a copy is provided.the state’s words, verbatim · CDSS document, May 15, 2024

Allegation investigated: Staff do not ensure facility is free from hazards

On November 8, 2023, Licensing Program Analyst (LPA) conducted an unannounced complaint visit. LPA met with house manager, Winnie Coronel and explained the purpose of the visit. Regarding to allegation of staff do not ensure facility is free from hazards, the reporting party stated that the facility re-furbished the deck and resulted nails protruding from the wooden floor slabs, uneven wooden floor slabs and the ramp from the family room into the deck has a mental plate on each side to create an even surface which was just a "band-aid fix." During today's visit, LPA toured the facility and interviewed facility staff. According to house manager, the deck was newly refurbished. However, the ramp from the family room leading into the deck remained the same. In addition, house manager reported that the metal plates on each side of the ramp is to ensure an even surface from the family room into the deck. Substantiated During today's visit, LPA observed multiple nails were protruding from the wooden floor slabs and some wooden slabs were cracked. These observations were acknowledged by the house manager. LPA observed the ramp from the family room leading to the deck to be sturdy and the mental plate at the end of the ramp created an even surface for residents who are in wheelchairs. According to the house manager, staff did not have any problems with wheeling residents around from the family room into the deck. LPA interviewed the administrator over the phone who stated that the facility has contacted a contractor to come to the facility for the nails and the slabs in the deck, however, the administrator was not able to provide any proof of the repair. Based on observations, and interviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegations were determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with the house manager. A copy is provided and Appeal Rights provided.the state’s words, verbatim · CDSS document, Nov 8, 2023 · control 14-AS-20231102111838

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Nov 9, 2023

87303 Maintenance and Operation..(a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by several nails protruding from the wooden floor slabs and a few cracked wooden slabs which poses an immediately health risk for residents in care.the state’s words, verbatim · CDSS document, Nov 8, 2023

Plan of correction: The administrator/licensee will provide a plan for the repair and on the plan, it shall include the date of repair to be completed and in the meantime, what is the facility's approach to ensure safety. The administrator/licensee will provide a copy of the plan and a photo(s)of the temporary fix to CCL by 11/9/2023.