Pacificare Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Pacificare Home. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 5 residents and the home currently has 6 residents. There is 1 resident on hospice during today's visit. Emmelita Magdaluyo has an administrator certificate expiring on 09/21/2027. LPA Lyman along with Caregiver Belleza toured the facility at 12:38 PM. LPA toured the physical plant, checked food service, facility records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, two common restrooms, living room, dining room, office, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed six residents with half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 106.5 and 108.5 degrees F in facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies and sharps under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gate is unlocked and self latching. LPA observed emergency food and water supply in the garage. LPA reviewed the emergency disaster plan and infection control during the visit. CONTINUED ON LIC 9099C DATED 05/07/2026 Both plans are thorough and complete. Facility provides activities in the form of games and exercise. LPA reviewed six resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports, resident appraisals and physician orders for bed rails as indicated. Staff files reviewed contained required documentation such as health screen/TB, criminal record clearance, first aid/ CPR and required training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. LPA observed four out of six residents have physician orders for blood pressure parameters. Based on the observations made during today’s visit, deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided as well as appeal rights.the state’s words, verbatim · CDSS document, May 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Pacificare Home. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the home and met with Caregiver Aiza Clemente. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 4 residents. There are 2 residents on hospice during today's visit. Emmelita Magdaluyo has an administrator certificate expiring on 09/22/2025. LPA Lyman along with Caregiver Clemente toured the facility at 12:52 PM. LPA toured the physical plant, checked food service, facility records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, two common restrooms, living room, dining room, office, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with half bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.8 and 108.3 degrees F in facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies and sharps under the kitchen sink. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gate is unlocked and self latching. LPA observed emergency food and water supply in the garage. LPA reviewed the emergency disaster plan and infection control during the visit. CONTINUED ON LIC 9099C DATED 05/12/2025 Both plans are thorough and complete. Facility provides activities in the form of games and exercise. LPA reviewed four resident files and three staff files. Resident files contained required documents including admission agreements, current physician reports, resident appraisals and physician orders for bed rails as indicated. Staff files reviewed contained required documentation such as health screen/TB, criminal record clearance, first aid/ CPR and required training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are audited monthly by staff. Medications are being administered per physician order. Based on the observations made during today's visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was given at time of visit.the state’s words, verbatim · CDSS document, May 12, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Annual inspection. LPA was greeted and allowed entry into the facility by care giver Aiza Clemente to whom LPA discussed the purpose of the visit. Later, Administrator Arturo Magdaluyo joined the visit. According to the facility’s license, the facility has a maximum capacity of six (6) non-ambulatory clients. Facility also has a hospice waiver for three (3). LPA, accompanied Administrator Arturo Magdaluyo, to continue the tour of 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. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant. Hot water temperature at taps accessible to clients were all compliant. No pools or body water present at facility. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. LPA also conducted an inspection of the centrally stored medications. They were properly locked in medication closet. Medication logs and medications reviewed were current. [Continued on 809-C] LPA conducted further interviews and per Administrator Arturo Magdaluyo, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed the theft and loss policy and procedures. Transportation procedures are compliant. LPA interviewed staff members and residents. LPA interviews did not raise any licensing concerns. Staff and resident records review verified that all staff records and residents are complete and compliant. Licensee presented proof of current liability insurance. Administrator’s certification is current. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator Arturo Magdaluyo, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Aug 20, 2024

Type of visit: Office

An Informal Conference was held on this date at the Orange County Adult and Senior Care Regional Office via Teams. At this informal conference, present were: Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst Kimberly Lyman and Licensee Emelita Magdaluyo. The following was discussed at the meeting: Decision and Order for Staff 1. Licensee agrees to disassociate the staff in the Guardian System. Exit interview conducted and a copy of this report will be emailed to Licensee.the state’s words, verbatim · CDSS document, Jul 18, 2024