Rancho Residential

Type of visit: Required - 1 Year

On 12/02/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct the annual inspection. This LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator. LPA met with Aileen Mendoza and a brief interview followed. This was the first annual inspection of this newly licensed facility. Mendoza explained that since returning to the area last month, they and their family have been living at the facility as there were no residents in care. LPA provided technical assistance with regard to adhering to their plan of operation. LPA stated that they needed to provide an addendum to their plan of operation stating that they would be living at the facility and to provide an updated facility sketch to Community Care Licensing. The addendum must also include their plan for caring for residents should they admit any while they are still residing at the facility. As they currently have small children, additional staff would be required and designated to provide supervision for either the residents or the children. Mendoza stated that their living situation was temporary, and that they would be moving out in their near future as their family would require more room. The children would not be present at the facility and childcare would not be an issue. The inspection began in the kitchen. This LPA reviewed all the food items in the refrigerator, freezer and cabinets/pantry. LPA observed a 7-day supply of non-perishable and 2-day supply of perishable food items. All knives and sharps were locked and inaccessible to any future residents in care. This LPA then went on to inspect the residents bedrooms. Each of the 5 bedrooms had the required furniture, furnishings and lighting to be in compliance at the time of this inspection. LPA provided technical assistance regarding required drawer space. LPA Inspected the 2 resident bathrooms and provided technical assistance regarding permanent grab bars for the shower/tub unit. LPA observed that the tub had a textured surface and stated that a best practice would be to also include bath mats as the LPA was unable to determine if their surfaces were non-skid/slip. LPA observed that the bathrooms also contained soap and paper towels replaced the cloth towels. Trash cans with lids were also present and there were no toxic cleaning supplies left accessible to future residents. LPA observed that the fire extinguisher was last inspected by Jorgensen Co. on 12/02/25 and was in compliance at the time of this inspection. This LPA conducted an examination of the exterior of the building. There were no bodies of water present and the yard was completely fenced in. There was also designated area with furniture and shade for future residents to enjoy. LPA observed that all windows, window screens, and gutters were in good condition and were not in need of repair. LPA requested the following documents be submitted to Community Care Licensing on or before the close of business on 12/12/25 along with photos of the re-installed grab bars: An updated Facility Sketch An Addendum to the Plan of Operation The materials will be emailed to CCLASCPSacramentoSouthRO@dss.ca.gov or faxed to the attention of LPA Kimberly Viarella at (916) 263-4744. LPA also reminded the Licensee that they MUST NOTIFY COMMUNITY CARE LICENSING WHEN THEY ADMIT THEIR FIRST RESIDENT SO THAT THIS LPA MAY SCHEDULE A POST-LICENSING INSPECTION. According to the California Code of Regulations, Title 22 no deficiencies were cited during today's visit, a copy of this report was provided and an exit interview was conducted with Mendoza.the state’s words, verbatim · CDSS document, Dec 2, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 11/8/24, at 1:30pm, Licensing Program Analyst (LPA), Arvin Villanueva conducted an announced inspection to the above facility for purpose of continuing their pre-licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on 3/22/24, for an Initial license for a Residential Care for the Elderly. The requested capacity is for 6 residents. LPA met the applicants, Tony Hoang and Aileen Mendoza and explained the purpose of the visit. LPA and Applicants conducted tour of the facility. All bedrooms are now fully furnished with beds, bedside table, lamp and spacious storage to accommodate resident belongings. Personal Rights and Complaint Poster were observed to be posted at the kitchen/livingroom area. LPA also reviewed application documents. LPA conducted component III orientation with the applicants, Tony Hoang and Aileen Mendoza. Pre-Licensing is now complete. No objections were made to licensure. Exit interview was held with applicants, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 8, 2024

The state marks this report as 6 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Prelicensing

On 9/24/24, at 2pm, Licensing Program Analyst (LPA), Arvin Villanueva conducted an announced inspection to the above facility for purpose of a pre-licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on 3/22/24, for an Initial license for a Residential Care for the Elderly. The requested capacity is for 6 residents. LPA was greeted and accompanied on inspection by the applicants, Tony Hoang and Aileen Mendoza. Facility is a single-story house located in a newly developed residential neighborhood. Facility has 6 single occupancy resident bedrooms and 3 full bathrooms. Resident bedrooms are located on the left side of the facility and right side are the garage, laundry, kitchen, living and dinning room. Outdoor Area: There is a covered patio going to the backyard. At this time it is not equipped with outdoor furniture. The backyard lawn bare and is not developed at this time. Per applicants, they plan to landscape in the future. Outdoor passageways, walkways, driveways, and steps are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Fence and gates are new and in good repair. No swimming pools/bodies of water at this time. Per applicants, they will not be adding bodies of water to the property. Residents' Bedrooms: LPA observed 6 resident bedrooms. The resident bedrooms are spacious and will easily accommodate the resident's furnishings. All bedrooms are fire cleared for bedridden residents. The facility is equipped with sprinkler system and each bedroom is equipped with sprinklers. 1 of 6 bedrooms (labeled owner's suite in the facility sketch) is fully furnished at this time. The other bedrooms are in the process of being furnished. Per applicants, they plan to accept residents who might be needing hospital beds. {Con't on LIC809-C} Bathroom: Facility has 3 resident bathrooms. 1 of 3 bathrooms is in the 1 bedroom (labeled owner's suite in the facility sketch). All bathrooms have working toilets, wash basins and full baths with showers. All bathrooms are equipped with non-skid flooring and close-lid garbage bins. LPA did not observed grab bars in the bathrooms. Per applicants they will be installing grab bars. LPA observed adequate lighting in hallways leading to bathrooms. Linens & Hygiene Supplies: Adequate supply of linen and hygiene supplies stored in linen closet, which is at end of the hall between the bedrooms. Emergency Phone Numbers, Exit Plan & Menu: The facility will utilize google voice via laptop for resident use. Emergency Disaster Plan will be posted & available for review on the wall. One fully charged fire extinguisher were found in hallway located in the kitchen/dining room. Fire extinguisher was last serviced on 7/10/24. Toxins: Toxins locked/stored under kitchen sink and in the laundry area and are inaccessible to residents. Water temperature: Hot water temperature was measured at 117*F in 1 of 3 bathrooms. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are in locked drawers. Smoke Detectors and carbon monoxide: Facility has smoke detectors/carbon monoxide monitor combination. LPA observed one in each resident bedrooms and in the foyer and in the kitchen/dining room/living room area. {Con't to LIC809-C} Appliances: Stove burners and oven are in good working condition. There is 1 refrigerator in the kitchen. Refrigerator and freezer are at the regulatory temperature for food storage. Washer and dryer are located in the laundry room. Medications, First-Aid Kit & Book: First aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and manual which are stored in locked cabinet in the kitchen area, available for staff use but inaccessible to residents. Residents & Staff Files: Applicant will not be handling cash resources of residents at this time but will submit necessary documents for any changes. Reading Material, Games, Equipment & Materials: During this visit, activity materials are not available at this time. Outside activity area is properly enclosed. LPA did not observed outdoor furniture at this time. LPA did not observed television for residents use at this time. Component III: Pre-licensing is not complete at this time. According to the applicants, they are not ready to finish the pre-licensing and component III at this time. Per applicants, they will be ready to resume the pre-licensing on 11/8/24. An exit interview was conducted with and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 24, 2024

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Mendoza, Aileen On 8/14/24, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Aug 14, 2024