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Allegation investigated: Staff yelled at resident

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Staff Ben Briones and explained the purpose of the inspection. Complaint alleges Staff yelled at Resident 1 (R1). Interviews were conducted with one witness, two facility staff, and four facility residents. During interview, R1’s responsible party, Witness 1 (W1) stated R1 is often confused and it is difficult to decipher whether R1’s statements are true or not. Per W1, R1 had stated that Staff 1 (S1) yelled at them, however, denied R1 indicating any other staff yelling at them and stated they did not know if staff had yelled at any other residents. LPA attempted to contact R1 by phone on three separate occasions, however, R1 could not be reached to confirm or deny allegation. During interview, S1 denied yelling at R1 or any other resident and denied having any knowledge of any other staff yelling at R1 or any other resident. (LIC9099-C) Unsubstantiated During interview, S2 denied yelling at R1 or any other resident and denied witnessing or having any knowledge of S1 yelling at R1 or any other resident. During interview, three of four residents denied staff yelling at them or any other resident and one out of four residents was unable to confirm or deny allegation. Due to allegation being uncorroborated during interviews conducted, LPA is unable to determine if Staff yelled at resident. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jun 17, 2026 · control 22-AS-20260610153149

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Claudia Gutierrez conducted an unannounced Case Management inspection in conjunction with investigation into complaint number 22-AS-20260518110245. LPA met with House Manager (HM) Ben Briones and explained the purpose of the inspection. During the course of the investigation, deficiencies were observed. LPA observed medication requiring refrigeration to be accessible in the kitchen fridge. Staff immediately took the medication and placed it in the staff refrigerator, which is inaccessible to residents and located in the garage. In the garage, LPA observed a twin bed made with linens and observed a dresser next to the bed with staff’s personal belongings, including toiletries and clothing. In a separate section of the garage, divided by furniture, LPA observed another twin bed made with linens with additional personal belongings, including shoes and clothes. Upon request of Staff 1’s (S1’s) file, HM was unable to provide any documentation pertaining to S1. During interview, Staff 1 (S1) stated they do not have a facility file and stated that they and another staff sleep in the garage. Based on observations made during this inspection, three deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, May 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: May 27, 2026

(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, the Licensee did not comply with the section cited above as LPA observed medication requiring refrigeration to be accessible in the kitchen fridge.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: Staff immediately took the medication and placed it in the staff refrigerator, which is inaccessible to residents and located in the garage. HM stated an in-service will be conducted to ensure centrally stored medicines are kept in a safe and locked place.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87412(a) · Plan of correction due date: May 27, 2026

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. This requirement is not met as evidenced by: Based on observation and staff interview, the Licensee did not comply with the section cited above as HM was unable to provide any documentation pertaining to S1 and S1 stated they did not have a facility file, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: HM stated they will complete a personnel file for S1 and a copy will be provided to LPA via email by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Jun 26, 2026

(a) Living accommodations...The facility shall be large enough to provide comfortable living accomodations and privacy for the residents, staff... This requirement is not met as evidenced by: Based on observation and staff interview, the Licensee did not comply with the section cited above as staff is currently residing in the garage, which poses a potential safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: HM stated staff will no longer reside in the garage and all their personal belongings removed. HM stated video proof will be provided to LPA via email by POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 and LPA met with Administrator (AD) Regie D. Banggalat and explained the purpose of the visit. The facility is a single story residence with a fire clearance of six ambulatory of which one resident may be bedridden. The facility has a hospice waiver for six. The facility has a census of four residents in care; with two residents recuperating in the hospital. Currently two residents receive hospice services. During the visit, LPA toured the kitchen and observed all appliances were in working order. Knives were stored in a locked tool box in a cabinet and additional knives and cleaning supplies were secured underneath the kitchen sink. Fresh fruit were observed on the table and the pantry and freezer had seven days of non-perishable supplies and the refrigerator had two days of perishables on-hand. LPA inspected smoke and carbon monoxide detectors and both alarms were in working order. The fire extinguishers were charged and serviced on March 17, 2026 and the facility conducted a quarterly fire drill on March 7, 2026. The facility temperature was 75 degrees and there were no odors detected. LPA observed the PUB 475 See Something, Say Something Poster, Personal Rights, Schedules, Liability Insurance and additional information in the hallway. LPA walked through resident bedrooms and all rooms had the required furnishings and linens. LPA inspected two of two resident bathrooms and the hot water temperature ranged from 113.3 to 117.5 degrees Fahrenheit. All showers had grab bars and non-skid flooring and covered trash cans were observed. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the exterior of the facility and there is ample space for outdoor walks and activities. There are no hazards or obstructions on pathways and there were several shaded seating areas for people to sit. Exterior gates are open and self-latching. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The facility has a First Aid Manual book on-site and the First Aid Kit had the required elements. LPA reviewed three of three staff training and fingerprint records sand conducted a complete review of resident records. All residents have Admissions Agreements that comply with Title 22 and Medical Assessments were updated and bed rail orders were observed. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on March 17, 2028. LPA provided a fact sheet with the Administrator about Legionnaire's Disease during the annual inspection. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Regie D. Banggalat, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Apr 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Bonifacio Briones, House Manager at 1pm. The facility is a single story residence with three resident bedrooms and one staff bedroom. The facility has an approved fire clearance of five non-ambulatory residents of which one may be bedridden and a hospice waiver for six. The facility currently has a census of six residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 117.8 and 127.0 degrees Fahrenheit and a Type A deficiency will be cited. House Manager was advised to lower water heater temperature and to secure cleaning products in the main bathroom cabinet. All smoke detectors were operational. The fire extinguisher is charged and was serviced on September 13, 2023. The facility did not have a fire drill on file. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. The weekly menu was posted on refrigerator. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid kit has all the required elements but did not have a First Aid book. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the exterior of the facility and observed a shaded seating area and ample room for outdoor activities. There are no hazards or obstacles in exterior passageways. All storage units were locked. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA requested to see bedrail orders for five of six residents but none were on file in physician's orders or hospice orders. Three of six resident records did not have a medical assessment or appraisal needs and services plan. A sixth resident recently moved in within a week and only had a hospice file. Type B deficiencies will be given regarding documentation. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on March 17, 2026. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Bonifacio Briones, House Manager and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Mar 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with House Manager Briones Bonifacio and was granted entry to the facility. The facility is a (4) bedroom (2) bathroom home and, with a kitchen/dining area, living room, and attached garage. Licensed capacity is (6) current census is (4). LPA was accompanied by House Manager Briones Bonifacio to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated space for client/staff files. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Record Review: LPA reviewed (4) client files for admission agreements, updated physician reports, medications and needs and services plans. 1 out of the 4 clients did not have an updated medical assessment. R1 has dementia and last medical assessment was conducted in 2022. Furthermore, facility did not have R1 Hospice Care Plan maintained at he facility. LPA conducted (3) medication audit. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Based on the observations made during today’s visit, two (2) Type B deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809)(LIC809D) was discussed and provided to House Manager Briones Bonifacio. Along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Jul 17, 2024