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Parkside Villa

Mid-size home·Licensed for 15·San Jose, California

Licensed since 2019Licence #435202647Medi-Cal ALW
(408) 831-7411From the state roster · September 27, 2026Plan a visit
  • Care approvals on fileHospice · BedriddenState licensing record · September 27, 2026
  • Estimated starting rate$4,850 a monthCovelight estimate · likely $3,800–$6,350
  • Home sizeLicensed for 15Mid-size care home · a licensed care home (RCFE)
  • Room at the last state visit15 of 15 beds occupiedJuly 30, 2026 · not a current opening
  • Ways to payMedi-Cal ALW acceptedDHCS participant list · August 9, 2026
  • Last state visitJuly 30, 2026CDSS inspection record

Parkside Villa is a mid-size care home in San Jose — a licensed residential care facility for the elderly (RCFE), the licence category behind “assisted living” and “board and care.” It is licensed for 15 residents since 2019. Wheelchair and non-ambulatory care and dementia care are not on file.

Built from CDSS public records · September 27, 2026. Every fact below names its source and date.

Quick answers and the state record

A citation does not make a home unsafe, and an empty file does not make a home good.

Quick answers about Parkside Villa

Is Parkside Villa licensed?

The state lists this license as “Licensed,” per CDSS records as of September 27, 2026.

How many residents is Parkside Villa licensed for?

15 residents — a mid-size home, per CDSS records as of September 27, 2026.

Has Parkside Villa been cited?

0 Type A and 0 Type B citations since 2019, per CDSS records as of September 27, 2026. Those records count 13 state visits over the same years.

Is Parkside Villa still open?

This license was on the CDSS roster as of September 28, 2026.

What does Parkside Villa cost?

$4,850 a month to start is a Covelight estimate, likely $3,800–$6,350. This home’s own rate is not on file. Ask: “What is the all-in monthly rate, and what would push it higher?”

Covelight’s estimate starts from the rates 8 homes with 7 to 49 beds and similar homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

Among 51 other homes of a similar licensed size in San Jose that publish a starting rate, the middle half runs $3,525 to $4,875 a month, and the middle figure is $4,200 (n = 51 other homes publishing a starting rate).

Each of those is a home’s own published figure, gathered on its own date in September 2026 — not an average of ours, and not a survey. Similar size means small and mid-size homes counted together, and large communities counted on their own, because they are different markets.

A home outside the band is not overcharging or underpricing: a starting rate covers different things in different homes, which is the first thing to ask about.

The price is made in the phone call. Nothing here is a quote, an offer or a discount.

A starting rate is the room and the base care. California homes commonly bill care levels, medication management, supplies, transport and a second person in the room as extras. Many also charge a one-time fee at move-in. Ask for that list in writing before anything is signed.

Only prices a home put out itself count here: its own website, a listing it supplied, or a price a listing site says the home confirmed. Prices a site shows without saying where they came from are left out. What Medi-Cal’s Assisted Living Waiver covers in a care home.

Does Parkside Villa take Medi-Cal?

On Medi-Cal’s Assisted Living Waiver: this home appears on the DHCS participation list, August 9, 2026. Confirm eligibility and current participation with the program. The waiver pays for care services, not room and board.

Who holds the license?

The license is held by Parkside Villa Inc., per CDSS records as of September 27, 2026.

Is there a hospital nearby?

Regional Medical Center of San Jose is 1.7 miles away in a straight line, per the CDPH licensed-hospital list dated September 16, 2026. See licensed care homes near it.

Can Parkside Villa keep a resident on hospice?

Hospice care is approved on this license, covering up to 15 residents, per CDSS records as of September 27, 2026.

Parkside Villa license and inspection record

  • Name on the license: “PARKSIDE VILLA INC”, per the CDSS roster as of May 25, 2025.
  • License #435202647. The state lists this license as “Licensed,” per CDSS records as of September 27, 2026.
  • Licensed for 15 residents — a mid-size home, per CDSS records as of September 27, 2026.
  • Licensed to Parkside Villa Inc., per CDSS records as of September 27, 2026.
  • First licensed in 2019, per CDSS records as of September 27, 2026.
  • 13 state inspection visits since 2019, per CDSS records as of September 27, 2026.
  • 0 Type A and 0 Type B citations on file since 2019, per CDSS records as of September 27, 2026. The same records count 13 state visits in that period.
  • 2 complaints and 0 substantiated allegations on file since 2019, per CDSS records as of September 27, 2026. One complaint can carry several allegations.
  • The most recent state visit on file is July 30, 2026, per CDSS records as of September 27, 2026.
Type A citationa violation that poses an immediate risk to health, safety or personal rights if it is not correctedType B citationa violation that could become a risk if not corrected, or one involving records, resources or required services

California writes these definitions for every licensed home, not for this one. CDSS citation definitions (PDF) ↗

See the state’s own record

Can they support the care needed?

California licenses a home for specific kinds of care. The state’s record lists what this home is approved for; the home’s own answers fill in what changes as needs change.

  • Wheelchair / non-ambulatoryNot on file · ask the home
  • Dementia / memory careNot on file · ask the home
  • Hospice careApproved · covers up to 15 residents
  • BedriddenApproved · covers up to 6 residents

State licensing record · September 27, 2026. An approval may cover specific rooms or residents; it does not establish an opening.

Read the state’s own wording
AGE RANGE 60 AND OVER 15 NON-AMB, OF WHICH 6 MAY BE BEDRIDDEN. LICENSE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE HOSPICE WAIVER FOR FIFTEEN (15) RESIDENTS.

935 - ELDERLY

CDSS record, verbatim · September 27, 2026

As needs change

  • Staying through hospice

    Hospice waiver on file · covers up to 15 — care may continue at the end of life

    Ask: “If hospice is needed, can care continue here until the end?”

    State licensing record · September 27, 2026

4 more questions to ask the home
  • Two-person transfers or a lift

    Not on file

    Ask: “If two people or a lift are needed to transfer, can the person stay?”

  • Someone awake overnight

    Not on file

    Ask: “Who is awake overnight, and how do residents ask for help?”

  • Medicines

    Not on file

    Ask: “Who manages the medicines, and what happens when a dose is missed?”

  • If memory loss develops

    Dementia-care designation not on file

    Ask: “If memory loss develops, what would change — and when would a move be needed?”

What it costs here

Covelight estimate

$4,850a month to start

Likely $3,800–$6,350

From 8 nearby homes that publish rates · this home’s rate is not on file

Likely monthly total

$4,850a month

Likely $3,800–$6,500

With a shared room and basic help.

An estimate for planning, not a quote. The price is made in the phone call.

See the full cost breakdownRoom, care and fees · how people pay · how this estimate works
Room
Daily care
Sharing the room

Memory care is not priced here: a dementia-care designation is not on file for this home. Ask the home.

  • Starting monthly rate$4,850likely $3,800–$6,350

    Covelight’s estimate starts from the rates 8 homes with 7 to 49 beds and similar homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

  • Basic help with daily careUsually includedup to $600

    Basic help is usually part of the starting rate. Homes that price care by level start around $600 a month (45 California homes publish a care-level range, seen in September 2026).

  • One-time move-in fee$2,000one time · likely $0–$4,000

    Homes that list a one-time entry or community fee charge a median of $2,000 (134 California listings; middle half $1,000–$4,000). Many homes list none — ask.

Likely monthly totalLikely $3,800–$6,500
$4,850
First monthWith a one-time move-in fee · likely $4,550–$9,450
$6,850
How people payOn the Medi-Cal waiver list · private pay, SSI/SSP, veterans, insurance
  • Private payMost residents pay from savings, a home sale or family help. Ask for the rate and what it includes in writing.
  • Medi-Cal Assisted Living WaiverThis home appears on the DHCS participation list, August 9, 2026. Confirm eligibility and current participation with the program. The waiver pays for care services, not room and board. For a resident on SSI/SSP, California’s 2026 standard sends $1,444.07 a month to the home for room and board.
  • SSI/SSPCalifornia’s 2026 standard is $1,626.07 a month; $1,444.07 of it goes to the home and $182 stays with the resident. Whether this home accepts it is not on file — ask.
  • VeteransVA Aid & Attendance can add to a veteran’s or surviving spouse’s pension. Ask whether residents here have used it.
  • Long-term care insuranceMost policies pay for licensed care homes. Ask what paperwork the home provides for claims.
  • MedicareDoes not pay for room and board in a care home. It can still cover hospice or home-health visits inside one.
If the money runs out, what Medi-Cal covers
Avoid surprises on the billWhat changes the price, and what to ask
  • The care level

    Some homes charge one all-inclusive rate. Others add levels or points as needs grow. Ask how the level is set, who decides, and what the next level costs.

  • What is billed separately

    Medication management, incontinence supplies, transportation and a second person in the room are often extra. Ask for the list in writing.

  • Move-in costs

    A one-time community fee or deposit is common. Ask what it covers and whether any of it comes back if the stay is short.

  • Increases

    California requires at least 90 days’ written notice, with reasons, before a rate rises (Health & Safety Code §1569.655). A change in the resident’s care level is the section’s own exception and can be billed sooner.

  • What is the full monthly cost for the room and care we need, and what does it include?
  • What would the next care level cost, and who decides when it changes?
  • What is billed separately, and is there a one-time fee or deposit at move-in?
  • Is any private-pay period required before another payment program can begin?
How this estimate worksWithin 25% for 7 in 10 homes in testing

Covelight’s estimate starts from the rates 8 homes with 7 to 49 beds and similar homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

8 homes like this within 3 miles publish starting rates mostly between $2,300–$5,000.

  • Only prices a home put out itself count: its own website, a listing it supplied, or a price Seniorly says the home confirmed. Prices a listing site shows without saying where they came from are left out.
  • Nearby homes are the nearest of the same size that publish a rate, widening from 3 to 40 miles until at least 8 do. The estimate starts from what they charge, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices.
  • Room, care-level, second-person and move-in lines come from what California homes publish on listing sites. Memory care uses Covelight’s researched premium over assisted living.
  • Totals add each line’s figure and combine the lines’ ranges as separate charges, because a home is rarely at the top, or the bottom, of every line at once.
  • We tested this estimate on 1,546 California homes that publish their own starting rate. It was within 10% of the real rate for 3 in 10 homes and within 25% for 7 in 10; the likely range held the real rate for 6 in 10 (September 12, 2026).
  • It cannot see this home’s specials, how it assesses care, or which rooms are open.
Show the 8 nearby homes behind this estimate

Where it is

  • 300 S 22Nd St, San Jose, CA 95116Address from the public record · September 27, 2026. Confirm the entrance with the home before visiting.

Opening the neighborhood map…

The state record

California inspects every licensed home and publishes what it found. Here are the dated documents and the state’s own words, beside what is typical for homes this size.

Since 2023, the state has filed 13 documents for this home, and its records count 13 visits since 2019. The most recent — a complaint investigation report on July 30, 2026 — closed with the state’s outcome word: “Unfounded.”

On file since
2023
State visits
13
Most recent visit
July 30, 2026
Occupied at that visit
15 of 15 bedsa count on that day, not an opening

We hold 2 complaint reports the state published for this home, dated September 23, 2025 to July 30, 2026. 2 of the 2 carry the state's recorded outcome word: “Unfounded” (1), “Unsubstantiated” (1). 2 include the transcribed allegation the state investigated, word for word. Summary composed by computer from the 2 complaint reports below — every count derives from them, and the documents themselves are the state's records, verbatim. We never grade, score, or color a record.

Beside homes the same size

  • Type A citations0typical 0
  • Type B citations0typical 0
  • Substantiated allegations0typical 0
  • Total complaints2typical 1

“Typical” is the statewide median across the 327 licensed mid-size homes (7–15 beds) in the state record — larger, longer-licensed homes accumulate more visits and reports, so compare like with like. One complaint can contain several allegations. Counts cover this licence since 2019.

Year by year
YearVisitsDocumentsSubstantiated2026220202588020242202023110

The last 36 months — 12 of 13 documents

The full record on the state’s site →
20262 state visits · 2 documents
Jul 30, 2026Complaint investigation reportUnfounded

Allegation investigated: Staff do not provide adequate supervision, resulting in residents leaving the facility unsupervised Staff did not respond to injured resident calling for help Staff is having residents perform personal services for him

On 07/30/2026 Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannouced complaint investigation and met with the facility designated administrator(DA) Ninfa Gozon and lead staff (LS) Lady Sheenely Angeles. LPA stated the purpose of the visit is to address a complaint received by the department on 07/22/2026. During today's 07/30/2026, LPA Partoza conducted an inspection and interview of 2 staff and found that the resident addressed in the complaint does not reside at the facility. The complaint will be redirected to the right facility where the individual resides. Cross reference complaint #26-AS-20260730094306. This department has investigated the complaint with the above allegations and found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies are cited during today's visit. An exit interview was conducted with Designated Administrator (DA) Ninfa Gozon and Lead Staff (LS) Lady Sheenely Angeles and a copy of the report was provied. Unfoundedthe state’s words, verbatim · CDSS document, Jul 30, 2026 · control 26-AS-20260722095609
Jan 8, 2026Facility evaluation reportReport on file

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with the designated administrator (DADM) Ninfa Gozon and stated the purpose of the visit. Licensee/Administrator Marie Janice Foronda-Cayabyab arrived at the facility at 9:45 a.m. and left at 12:00 for a prior appointment The facility is licensed for adults 60+; up to 15 may be non-ambulatory. 6 maybe bedridden, and hospice waiver for 15. LPA observed residents and staff present, 14 out of 15 residents were out attending day program and 1 out of 15 was left at the facility and was resting at the time of the visit. LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, and outdoor spaces and storage areas. Indoor temperature was within acceptable range of 70°F. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). Kitchen water temperature measured at 112.6°F. Bathroom water temperature ranged from 105°F to 112.6°F. Bathrooms had grab bars and non-skid mats; resident rooms had adequate storage. Medications were locked and inaccessible to residents; first aid kit was complete. Outdoor areas were free of hazards; laundry appliances were functional, and cleaning supplies were secured. Fire, smoke, and carbon monoxide systems were operational; hallways were clear and well-lit. page 1 of 2 The facility has motion sensors to alert any movements in the hallways at night time. LPA observed a storage shed at the back of the property that is used to store dry goods and a portion was converted as a activity place for residents to use. LPA reviewed resident and staff records, including medication logs, admission agreements, care plans, personal and incidentals, health screenings, and training. All staff have required clearances and certifications. The facility conducts fire and earthquake drill quarterly for each shift. Last drill practice training was on 01/03/26, 1/4/26, 1/5/26. The facility is equipped with panel fire alarm system and 4 fire extinguisher were inspected on 04/21/2025. No deficiencies were cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted with DADM Ninfa Gozon and a copy of the report was provided. end of report page 2 of 2the state’s words, verbatim · CDSS document, Jan 8, 2026
20258 state visits · 8 documents
Dec 11, 2025Facility evaluation reportReport on file

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced case management visit regarding the incident that happened between two resident. LPA met with designated administrator Ninfa Gozon and stated the purpose of the visit. On 10/22/2025, the Department received an incident report regarding intimacy between two residents. On 10/23/25 and 11/05/25 the Department conducted an investigation and interviewed R1 and R2, 2 staff and the administrator. Based on interview, the facility staff was not aware that R1 went to R2s room without invitation from R2 at approximately 0200 hrs. R1 is high functioning, and can communicate and express his/her thought and gave his/her account of what happened. R2 is developmentally challenged, and cannot fully express himself/herself. R2 gave an unclear account if the intimacy was consensual or forced. Based on observation and document review, R1 is high functioning and is able to verbalize and communicate clearly. R2 is developmentally challenged and is not able to articulate and give detailed account of the foregoing event. Based on interview of staff 2 (S2) and administrator (ADM) both stated that R1 is high functioning. R2 is less verbal and has a hard time communicating and verbalizing and is not able to give account of the foregoing event. page 1 of 2 Based on observation and interview, staff 1 (S1) admitted that he/she was not aware that R1 went to R2s room and had intimacy in R1s room. S1 stated that he/she was busy watching on his/her tablet and have no line of sight of the hallways from the kitchen. S1 stated that most residents were asleep in the wee hours of the morning. The kitchen was closed and his/her line of sight was obstructed. S1 stated he/she did not hear R1 and R2 walking. S1 stated that he/she is the nocturnal (NOC) shift staff and supervises residents ensuring that they are asleep and not walking around disturbing other residents. Based on observations, interviews and document reviews. S1 did not provide care and supervision as identified in the client's needs and services plan as necessary to meet the client's needs. R2 requires care and supervision due to his/her her developmental capability and level of understanding. R1 stated he/she tiptoed to R2s room. R1 stated he/she knows that he/she is not allowed to go to the opposite gender's room without proper consent. S1 stated, he/she did not hear and see R1 and R2 walking because he/she was inside the kitchen with obstructed view of the open living area and dining area at approximately 0200 hrs. Therefore the preponderance of evidence that there is neglect and lack of supervision is substantiated. Deficiencies were cited during today's visit based on California Code of Regulations (CCR) Title 22, 85065.6 night supervision. See LIC 809D. An exit interview was conducted with designated administrator Ninfa Gozon. A copy of the report and appeals rights were provided. end of report page 2 of 2the state’s words, verbatim · CDSS document, Dec 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 85065.6(b) · Plan of correction due date: Dec 12, 2025

85065.6 Night Supervision (b)Employees providing night supervision from 10:00 p.m. to 7:00 a.m., as specified in (c) through (f) below, shall be available to assist in the care and supervision of clients in the event of an emergency...This requirement is not met as evidenced by: Based on interview & record review, the licensee did not ensure that staff was providing care and supervision from 10:00p.m to 7:00 a.m. to residents in care. When R1 tiptoed to R2s room and tiptoed back to his/her room to have sex with R2 in R1s room and S1 did not get alerted. S1the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: stated he/she was watching on his/her tablet at the time of the incident between R1 & R2 which pose/poses an immediate health, safety and personal rights risk to persons in care. DADM stated that he/she will submit a written plan of correction to address the NOC shift staff not being present and visible to provide care & supervisions from 10:00 pm to 7:00 a.m.. DADM willl submit plan of correction to LPA by the due date 12/12/2025.

Nov 5, 2025Facility evaluation reportReport on file

Type of visit: Case Management - Incident

On 11/05/2025, Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced case management - incident visit and met with Ninfa Gozon designated administrator (DADM). LPA stated the purpose of the visit. LIC/ADM Janice Cayabyab was unavailable due to prior commitment. On 10/22/2025, the Department received an incident report regarding a consensual intimacy between two residents and on 10/23/25, the Department conducted an initial investigation. On 11/5/2025, LPA Partoza conducted additional interview with staff and resident 2 (R2). Based on the information, it has been determined that the case management needs further investigation. No deficiencies are cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted and a copy of the report was provided to Designated Administrator Ninfa Gozon.the state’s words, verbatim · CDSS document, Nov 5, 2025
Oct 23, 2025Facility evaluation reportReport on file

Type of visit: Case Management - Incident

On 10/23/2025, LP Maria (Mita) Partoza, conducted an unannounced case management - incident visit. LPA was greeted by Ninfa Gozon and Lady Sheenely Angeles - who were both present at the facility and are the designated administrators. Licensee/Administrator (LIC/ADM) Marie Janice Cayabyab, arrived at 10:00 a.m. and met with LPA. LPA stated the purpose of the visit. On 10/22/2025, the Department received an incident report regarding a consensual intimacy between two residents. The department conducted an initial investigation of the incident and obtained documents such as LIC 500, staff schedule, and job duties and descriptions of staff. The Department conducted an interviews staff and resident (R1). Based on the information, it has been determined that the case management needs further investigation. No deficiencies are cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted and a copy of the report was provided to LIC/ADM Marie Janice Cayabyab.the state’s words, verbatim · CDSS document, Oct 23, 2025
Sep 29, 2025Facility evaluation reportReport on file

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted and unannounced case management-Incident visit to deliver the finding of the investigation. LPA was met by designated administrator (DADM) Ninfa Gozon and LPA stated the purpose of the visit. On 09/11/2025 the Department received an incident report and SOC341 regarding an inappropriate touching of one of the resident (R1) while attending a day program by the day program's staff (DPS1). The incident happened while R1 was being transported by DPS1 to his/her work site. On 09/12/2025, LPA conducted a collateral visit where the incident happened. LPA inquired about the incident and was able to determine that DPS1 is not an employee of the licensed facility and R1 is not a participant of the licensed facility. The Community Care Licensing Division (CCLD) has no jurisdiction over an adult day program that is not licensed by CCLD. This agency has investigated the incident of inappropriate touching and found that the incident was unfounded based on the information that was obtain during the initial investigation. The case was referred to other agencies who has jurisdiction of the adult day program. No citations are issued during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted with Designated Administrator Ninfa Gozon, and a copy of the report was provided. End of Reportthe state’s words, verbatim · CDSS document, Sep 29, 2025
Sep 23, 2025Complaint investigation reportUnsubstantiated

Allegation investigated: Staff did not allow client to return to the facility upon discharge from Hospital

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Lead Staff Felicitas Ventura, who contacted facility Administrator via phone call. ADM stated she was currently at a meeting. ADM stated her lead staff, Felicitas Ventura could sign on her behalf. On August 14, 2025 the Department received a complaint alleging Staff did not allow client to return to the facility upon discharge from Hospital. Page 1 Out of 3. Unsubstantiated On August 5, 2025, the Department received an incident report for resident R1. The incident report stated, On August 4, 2025, at approximately 5:00 PM, R1 approached kitchen staff while they were doing dishes and R1 stated that he/she was "having an episode," (this usually means that R1 is about to have an outburst or a meltdown). Staff noticed that R1's voice began to escalate in volume. Another staff member overheard the interaction and attempted to redirect R1 by inviting him/her outside for fresh air and a conversation. Staff then asked R1 if he/she would like to take his/her PRN medication, and R1 agreed. However, while staff were preparing the PRN medication, R1 suddenly became physically aggressive, thinking that staff were talking about him/her. R1 misinterpreted a conversation between two staff members about food as being directed at R1. R1 then attacked a staff member attempting to choke him/her. Other staff immediately intervened and R1 eventually released the staff member. Staff called 911 for police assistance. Police and paramedics arrived shortly thereafter. Paramedics assessed and assisted the injured staff. R1 was subsequently transported to the hospital for further evaluation and intervention. On August 22, 2025, LPA Monter interviewed staff S1 and ADM. S1 stated on August 4, 2025, R1 stuck a staff member around 5pm. S1 stated R1 was taken to the hospital that day by the police. S1 stated on August 5, 2025, hospital staff spoke with ADM. S1 stated the ADM requested if R1 can stay for another night. S1 stated the ADM spoke to a staff at the hospital who confirmed with the doctor at the hospital that R1 can stay for 1 more night, but R1 needed to be picked up the following day. S1 stated R1 was picked up on August 6, 2025, around 11:30am. ADM stated the timeline of events were as follows: On August 4, 2025, R1 had a violent behavior towards staff and the police were contacted, and R1 was taken to the hospital. ADM stated she was contacted the next day around 1:00pm. ADM stated she asked hospital staff if R1 could stay an additional night. ADM stated hospital staff confirmed it was ok for R1 to stay an additional night. ADM stated R1 was picked up on August 6, 2025. LPA Monter interviewed staff S1. S1 stated he/she was at the facility on August 4- 6, 2025. S1 stated on August 4, 2025, R1 stuck a staff member around 5pm. S1 stated R1 was taken to the hospital by the police. S1 stated the next morning (August 5, 2025), hospital staff spoke with ADM. S1 stated the ADM requested if R1 can stay for another night. S1 stated the ADM spoke to a staff at hospital who said he/she would relay info to the doctor. S1 stated Around 4pm, ADM called again, and hospital staff confirmed that R1 can stay for 1 more night but picked up the following day. S1 stated R1 was picked up on August 6, 2025, around 11:30am. Page 2 Out of 3. On August 25, 2025, LPA Monter interviewed Witness W1. W1 stated on August 5, 2025, he/she was called by hospital staff, who stated the care home asked to keep R1 for another night. W1 stated he/she tried to get a hold of the care home. W1 stated he/she didn’t get response that day. W1 stated the next day, he/she was informed by the care home that they would pick R1 up that day. (August 6, 2025) On August 26, 2025, LPA Monter contacted the hospital where R1 stayed. Hospital staff informed LPA they could not provide any information regarding R1’s stay at the hospital, as he/she is no longer currently staying at the hospital and also due to HIPPA. On August 26, 2025, LPA Monter interviewed R1's Service coordinator (SC). SC stated, once the hospital determines it’s a safe discharge, then the care home is supposed to accept R1 back. SC stated if there is a concern, violent, danger or violent. Then the facility can discuss with hospital and talk to the psychiatrist and doctor and come up with a plan. SC stated R1 returned to the facility on August 6, 2025. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegation was UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur. No deficiencies were cited from California Code of Regulations, Title 22 during today’s visit. This report was reviewed with Administrator MARIE FORONDA-CAYABYAB and a copy of the report was provided. Page 3 Out of 3. END OF REPORT.the state’s words, verbatim · CDSS document, Sep 23, 2025 · control 26-AS-20250814155156
Sep 11, 2025Facility evaluation reportReport on file

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted and unannounced case management-incident inspection visit. LPA was met by two designated administrators Ninfa Gozon and Lady Sheenely Angeles. LPA stated the purpose of the visit. On 09/11/2025 the Department received an incident report and SOC341 regarding an inappropriate touching of a resident by the day program's staff (DPS1). The incident happened while the resident was in transit inside the DPS1s own vehicle. LPA conducted an interview with the resident (R1), and 2 staff ( S1 and S2). R1 stated that the inappropriate touching happened two times, the first was on 09/02/2025, which R1 did not report. R1 stated he/she was in fear of retaliation from DPS1. The second time was on 09/09/2025 which was the one reported on the incident report. LPA received 3 declaration statement from R1, S1 and S2 and copies of R1s LIC 602. Individual Program Plan (IPP) and appraisal needs and services plan. At the time of the visit law enforcement officers came and interviewed R1. This has been determined that the incident needs further investigation. No citations were issued during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Ninfa Gozon and Sheenely Angeles designated administrators, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 11, 2025
Jan 8, 2025Facility evaluation reportReport on file

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with lead staff Ninafa Gozon (S1). During the visit, LPA observed 3 residents and 3 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 4 restrooms and 8 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. LPA observed a storage unit in the backyard, which is being used as storage. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 77 degrees F, and hot water temperature was measured to range from 108-115 degrees F in resident bathrooms. Fire extinguisher was serviced in April 22, 2024. The facility was equipped with smoke and carbon monoxide detectors were last tested in January 1, 2024. Staff S1 stated the facility has a scheduled sprinkler system inspection on January 19, 2025. S1 stated she would send LPA a copy of the report. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on December 23, 2024. LPA reviewed facility records for 5 staff and 5 residents. LPA reviewed 5 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff and 2 residents. No deficiencies cited during today's visit. This report was reviewed with Lead Staff Ninfa Gozon and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Jan 8, 2025
Jan 2, 2025Facility evaluation reportReport on file

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management Visit and met with Sheena Angeles, Assistant Administrator. The purpose of the visit was to follow up with an incident that the facility self-reported to the Department on 11/21/2024. The incident occurred on 11/20/2024 and involved resident R1 falling to his/her knees while standing near the laundry area of the facility. Staff assessed R1 and R1 was unable to move his/her right leg. The administrator instructed staff to call 911 and R1 was taken to the hospital. At the hospital, R1 was assessed and determined to have a right femoral neck fracture. LPA Marrufo conducted a visit on 11/22/2024 and obtained copies of R1's Physician's Report, Appraisal/Needs and Services Plan, and other resident records. During today's visit, LPA Marrufo interviewed Assistant Administrator Sheena Angeles and staff S1. S1 stated to have witnessed R1 fall on 11/20/2024. S1 stated that R1 was in front of the facility washing machine and was washing his/her clothing, when R1 turned around and fell to his/her knees. S1 stated to have provided a chair to R1 to assist R1 in getting back up. S1 stated that 911 was called for R1. S1 stated that paramedics arrived at the facility and took R1 to the hospital. During today's visit, Assistant Administrator Sheena Angeles stated that R1 is still at a rehabilitation facility and is awaiting discharge to return to the facility. R1's Physician's Report was signed by R1's physician on 09/11/2024. R1's Physician's Report states R1 is ambulatory. See LIC809-C page for more information. Page 1 of 2. R1 had prior falls on 01/18/2024 and 11/02/2024, which were both reported by the facility via Unusual Incident/Injury Reports. After R1's fall on 01/18/2024, staff brought R1 to the Emergency Room. R1 was not admitted to the hospital and sent back to the facility. LPA Marrufo interviewed Administrator (ADM) Marie-Janice Cayabyab over telephone during today's visit, and ADM stated that R1 was taken to R1's Primary Care Physician (PCP) on 01/30/2024. The Unusual Incident/Injury Report that reported R1's 11/02/2024 fall indicated R1's PCP advised staff to continue monitoring R1 for unusual symptoms such as dizziness or loss of balance. ADM stated during interview that staff were made aware of the PCP's advisory for R1. ADM stated that if R1 returns to the facility with a change of condition, then R1's Appraisal/Needs and Services Plan will be updated accordingly. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Assistant Administrator Sheena Angeles and a copy of this report was provided. Page 2 of 2. END REPORTthe state’s words, verbatim · CDSS document, Jan 2, 2025
20242 state visits · 2 documents
Nov 22, 2024Facility evaluation reportReport on file

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management Visit and met with Sheena Angeles, Assistant Administrator. The purpose of the visit was to follow up with an incident that the facility self-reported to the Department on 11/21/2024. The incident occurred on 11/20/2024 and involved resident R1 falling to his/her knees while standing near the laundry area of the facility. Staff assessed R1 and R1 was unable to move his/her right leg. The administrator instructed staff to call 911 and R1 was taken to the hospital. At the hospital, R1 was assessed and determined to have a right femoral neck fracture. During visit, LPA Marrufo obtained copies of R1's resident records and staff records. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Assistant Administrator Sheena Angeles and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 22, 2024
Jan 26, 2024Facility evaluation reportReport on file

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mita Partoza conducted an unannounced required annual inspection to the facility. The inspection was originally started on 1/24/2024 and this report is a continuation of the unannounced required annual visit. LPA met with administrator (ADM) Marie Jan Foronda-Cayabyab and amended the record that was erroneously recorded at a different facility on 1/24/2024. During today's visit 1/26/2024. LPA met with ADM and 5 staff. Currently the facility has 15 residents and 15 Out of 15 are ambulatory. During visit, LPA toured the facility to include the living room, dining room, kitchen, bedrooms, bathroom, storage area, and backyard. Staff room was inspected, 2.5 bathroom were inspected. The room temperature measured at 68-75F and the hot water temperature measured from 114.6F to 117.7F LPA with ADM tested the fire alarm and carbon monoxide system and found to be in good working condition. Night lights are also observed and are in good working condition. All designated emergency exits and passage ways are clear from obstructions. LPA observed the fire extinguisher in the kitchen is missing inspection tag that needs to conform with the regulations adopted by the State Marshall. page 1 of 2 continued on page 2 (LIC 809C). continued from page 1 (LIC 809) Toiletries such toilet paper, paper towels, toothpaste are inspected and found to be in ample supply. Toxic materials such as laundry detergent, disinfectant are inaccessible to residents and stored in a locked cabinet. LPA observed there is ample amount of perishable food for 2 days and 7 days non-perishable food supply for residents and staff as required by regulation. LPA and ADM reviewed 7 resident record, the resident's centrally stored medication and destruction record (CSMDR) and their P&I (cash resource) and found that all records are updated per regulations with no discrepancy. All designated emergency exits and passage ways are clear from obstructions. Staff and Administrator were reminded about infection control plan. A deficiencies was cited per California Code of Regulations, Title 22 during today's visit. This report was reviewed with administrator Marie Jan Foronda-Cayabyab. end of report page 2 of 2the state’s words, verbatim · CDSS document, Jan 26, 2024
What the state’s words mean
Substantiatedthe state found the allegation more likely true than notUnsubstantiatedthere was not enough evidence to prove a violation occurred — not a finding of wrongdoingUnfoundedthe evidence showed the allegation was false, could not have happened, or had no reasonable basisType A citationa violation that poses an immediate risk to health, safety or personal rights if it is not correctedType B citationa violation that could become a risk if not corrected, or one involving records, resources or required services

CDSS citation definitions (PDF) ↗ · CDSS complaint outcomes ↗

An “unsubstantiated” complaint is not a finding of wrongdoing — it means the state investigated and could not confirm the allegation. Outcome words are the state’s own; we never grade, score, or color a record, and we publish no reviews — the state’s dated documents and the questions below stand in their place.
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