Princeville - College Park

Type of visit: Required - 1 Year

On February 11, 2026, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley introduced self and was granted entry into the facility, after stating the purpose of the visit to Administrator Myriam Oliver. Administrator Karl Padua arrived shortly to assist with the visit. The facility is licensed to operate for six (6) non-ambulatory, with a Hospice waiver for four. The building is a one-story home located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, two and one-half bathrooms, living room area, kitchen, outdoor covered seating area, and an attached two car garage. During the visit, LPA toured the inside and outside of the physical plant with AD Olivier. There were no bodies of water or obstructions on the premises. All rooms were inspected, beds and bedding supplies were in good condition, and storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. A comfortable temperature of 76 degrees F was maintained throughout the facility. Bathrooms were found to be clean and operational, with water temperatures in bathrooms measured between 112 degrees F and 116 degrees F. The smoke alarms and carbon monoxide detectors were operable. First aid kit is maintained and contains all the necessary elements. Emergency safety drills were last conducted on December 18, 2025. The facility has one (1) fire extinguisher that was charged and purchased on February 11, 2026. CONTINUE LIC809-C..... Current Liability Insurance was provided during the visit with a policy start date of March 11, 2025 through March 11, 2026. A working telephone (562)296-8800 remains available and the facility has a device that can be used for video teleconference purposes. LPA conducted an audit of five (5) resident files (R1-R5), three (3) staff files (S1-S3), and medication and medication administration record review. Resident and staff interviews were conducted. Based on today’s observations and record review, deficiencies were cited during this visit, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrators Myriam Oliver and Karl Padua, and a copy of this report, LIC809-D, and appeals right were provided at exit.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Required - 1 Year

On September 26, 2025, at 9:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Karl Padua and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for four (4) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio area, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Padua. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be clean and operational. The water temperature measured 127.2 degrees F to 127.8 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the garage. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The PUB 475 poster measured at 13”x19”. The smoke detectors and carbon monoxide detectors were operable. A working telephone (562-296-8800) and laptop with videoconferencing technology both remain available. First Aid kit had all the necessary elements. The facility has one (1) fire extinguisher that was charged, mounted next to the staff bedroom that was serviced on November 23, 2024. Emergency drills are conducted quarterly and were last conducted on September 20, 2025. Evidence of liability insurance was effective from March 11, 2025, to March 11, 2026. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S2), and medication and medication administration record that were all in order and complete. LPA Kim conducted interviews with one (1) staff and one (1) resident. A deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). Hot water temperature in bathroom #1 measured at 127.5 degrees F, bathroom #2 measured at 127.2 degrees F, and bathroom #3 measured at 127.2 degrees F. A Technical Violation was assessed during the visit. PUB475 measured at 13”x19”. An exit interview was conducted, and a copy of this report, appeal rights, and LIC9102 were provided to Administrator Karl Padua.the state’s words, verbatim · CDSS document, Sep 26, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:00 AM, LPA Tea was greeted and granted entry into the facility by caregiver, Jose Vasquez Jr. and explained the reason for the visit. The Administrator (AD), Myriam Oliver is currently off today, the backup Administrator (AD) Karl Padua from their sister facility Princeville - Bolsa Chica arrived shortly after to assist during the visit. The facility is licensed for 6 non-ambulatory residents, with a hospice waiver for four. Currently there are three residents, of which one is on hospice during today's visit. Around 8:21 AM, LPA Tea reviewed three resident files and one staff file. Resident files and staff file contained all required documentation. Upon review of records, the facility is up to date with required quarterly fire drill, which was last conducted in June 07, 2024. AD Oliver current certificate expires on June 10, 2026, but due to the department’s back log in processing administrator certificates she has yet to physically receive her administrator certificate. LPA Tea along with the AD Padua toured the facility at 9:03 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 5 resident bedrooms, one staff room, which is kept locked, 2 full bathrooms and 1 half bathroom, living room, dining room, kitchen and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. 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 113.5 F degrees and 118.2 F degrees. 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. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Annual continuation on LIC809-C LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to clients in care underneath the kitchen sink. Fire extinguisher was fully charged in the kitchen. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating underneath a shaded patio area in the backyard. There is a water fountain and flowers surrounding the seating area. There are two exit gates that are self-latching and operational on both sides of the house. LPA observed emergency water supply and other supplies in the garage. There is emergency food stored in the pantry in the kitchen. Facility provides activities based on their personal choice, residents sometimes work on puzzles with the staff, and they play bingo. At the time of the visit, LPA observed residents enjoying breakfast together in the dining room and lounging in the living room watching television. At 9:26 AM LPA reviewed medication storage and administration. Medications are stored in a locked closet by the front entryway. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator Karl Padua and a copy of this report LIC809, along with the 809-C, LIC858, LIC859 and LIC9102 were read and provided to the facility.the state’s words, verbatim · CDSS document, Aug 2, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.