Santo Nino Residential Care Home #1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Dhorydel Sison Administrator, (ADM). LPA announced the purpose of the visit. LPA observed 1 staff and 4 residents. During visit, LPA toured the facility inside and out. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature measured at 40 Degrees F. LPA toured three resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. LPA toured 1 full resident bathroom and 1/2 bathroom. Bathrooms had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 109.7-110.8 degrees F. ADM tested the smoke detector in the kitchen and found smoke detector to function properly when tested. LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 11/26/25. LPA reviewed Fire and Earthquake log. The last disaster drill was conducted on 10/15/25. LPA reviewed resident records for 3 residents. LPA reviewed 2 staff records, 1 out of 2 staff file was not at the facility. ADM and LPA reviewed Centrally Stored medication for 3 residents. Deficiency was cited as per California Code of Regulations Title 22. Technical violation issued see LIC9102. This report was reviewed with ADM and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 22, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff are not addressing bedbugs in the facility

Licensing Program Analysts (LPAs) Marcella Tarin and Manuel Monter arrived unannounced to deliver the findings of a complaint investigation. LPAs met with Licensee Teodora Sison and stated the purpose of the visit. On 3/13/2025, the Department initiated the complaint investigation. During the investigation LPAs toured resident’s bedroom 1 to 3. LPAs inspected all resident bed sheets and observed small dark spots, black in color and reddish, rusty stains on the sheets. Powder residue was observed on the baseboard and on floors of 3 out of 3 resident bedrooms, which ADM stated they recently had the place fumigated due to the bedbugs infestation. Page 1 of 2. Substantiated LPA Partoza interviewed 3 residents and ADM. R1, R2 and R4. 1 out of 3 stated he/she have rashes but cannot identify if it is a bedbug bite. 1 out of 3 stated, he/she has rashes and showed the rashes to LPAs. 1 out of 2 stated he/she does not have any rashes or bedbug bites. ADM stated, the facility currently has called the exterminator and the place was treated for bedbugs on 3/10/2025. ADM stated the bedcovers were not replaced and the black spots were residue of bedbug’s eggs after the fumigation. On 3/14/2025, LPAs interviewed R3 who stated he/she has observed bedbugs in her bedroom. LPAs also toured bedroom 2. LPAs opened a dresser top drawer next to R5s bed and observed a bedbug inside the drawer (photograph taken). LPA inspected resident's R3' mattresses and observed 2 bedbugs on R3s bed sheets (photograph taken). Based on observation, interview and record review, the preponderance of evidence has been met and the allegation has been SUBSTANTIATED. A deficiency is being issued during today’s visit based on California Code of Regulations (CCR) Title 22. See LIC 9099D. An exit interview was conducted with Licensee Teodora Sison. A copy of the report and appeals rights were provided.the state’s words, verbatim · CDSS document, Mar 14, 2025 · control 26-AS-20250307092311

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Mar 15, 2025

87468.1 Personal Rights of Residents in All Facilities (a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on observation, record review and interview the licensee did not ensure resident's bedroom and furnishings were free from bedbugs, which poses an immediate health, safety and personal rights risk to 4 residents in care.the state’s words, verbatim · CDSS document, Mar 14, 2025

Plan of correction: Licensee stated they will submit a written plan of action on how they will ensure resident's bedrooms are free from bedbugs. Licensee/ADM will seek professional help if the issue cannot be addressed. Licensee stated they will submit the written plan of action to the Department by POC due date 3/15/2025.

Type of visit: Case Management - Other

Licensing Program Analyst Marcella Tarin and Manuel Monter conducted an unannounced case management to issue a Civil Penalty that was inadvertently not issued on 3/13/2025. LPAs explained the purpose of the visit. The Department is issuing an immediate civil penalty of $250 for a repeat violation for the following deficiencies: On 12/26/2024 the facility was cited under code section 87303(a) Maintenance and Operation during an annual inspection. On 3/13/2025 the facility was cited a repeat violation under code section 87303(a) Maintenance and Operation during a Case Management-Other. This report was reviewed with Licensee Teodora Sison. An exit interview was conducted with Licensee Teodora Sison, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 14, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPAs) Mita Partoza and Marcella Tarin conducted an unannounced complaint investigation and observed deficiencies while conducting inspection. A case management was initiated for the deficiencies that were found during the complaint investigation that is not related to the complaint. During the tour LPAs observed 3 resident R1-R3, and 1 staff. R1, R2 were watching TV in the living room, and R3 was in their bedroom. LPAs observed staff (S1) was in the kitchen preparing food. LPAs observed Licensee in staff room with S1s grandchild under the age of 5. R4 arrived after an hour. LPAs toured the interior and exterior of the facility and observed that the facility required maintenance, 4 bedroom were observed to have unknown powder residue on the floor. ADM stated it was sprayed by the exterminator to prevent bedbugs from repopulating. LPAs observed dust and cobwebs throughout the facility, a broken window screen outside bedroom #4, an uncovered waste basket in bedroom #1 with unknown stain brown in color and splattered on the wall next to the waste basket. LPAs observed Comet cleaning product in a bathroom, accessible to residents in care. During the visit, LPAs requested for one resident record file and observed R4s file did not contain a current LIC602, the last assessment recorded was on 9/7/2020. ADM stated that he/she was not aware that LIC 602s (Physician's Report) needs to be updated. LPAs provided a technical assistance to ADM regarding updating medical assessment as required by the Department. During the facility's annual inspection on 12/26/2024, deficiencies were issued for records not being available for LPAs review. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. An exit interview was conducted with Administrator Dhorydell Sison and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 13, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Mar 13, 2025

87303 Maintenance and Operation (a) The facility shall be...in good repair at all times,...for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by Based on observation the licensee did not ensure the facility was in good repair at all times. LPAs observed dust, cobwebs, a broken window screen exterior of Bedroom 4, uncovered waste basket in bedroom 1 with unknown brown residue on the wall next to the wastethe state’s words, verbatim · CDSS document, Mar 13, 2025

Plan of correction: Licensee states she schedule a general cleaning of the facility to ensure facility shall be in good repair at all time for the safety of residents, employees and visitors. Written plan of correction will be submitted to the Department by POC due date 3/14/2025. cont.--basket, which poses an immediate health, safety, or personal rights risk to 4 residents in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Mar 13, 2025

Storage Space and Acess (a) .. the licensee shall ensure that disinfectants, cleaning solutions... which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by Based on observaton and the licensee did not ensure cleaning solutions were inaccessible to 4 residents in care. LPAs observed Comet cleaning product on top of a toilet in bathroom outside of bedroom #2, which poses an immediate health, safety, or personal rights risk to 4 residents in care.the state’s words, verbatim · CDSS document, Mar 13, 2025

Plan of correction: Licensee removed Comet cleaning product during visit. Licensee states that all staff will be instructed to remove and lock cleaning products away. Licensee will submit a written statement of understanding of the regulation cited to the Department by POC due date 3/14/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Dhorydell Sison. During the visit, LPA observed 4 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 3 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. While touring the bathroom next to bedroom #2, LPA observed the sliding shower door was stuck. ADM stated she doesn't know how long its been stuck. LPA also observed the screens in the bathroom windows between bedroom #3 and & 2 had dirt/grime on the screens (Photographs were taken.) While touring the bathroom closest to bedroom #3, LPA observed the sink was clogged. (Photograph was taken.) While touring the outside of the facility, LPA observed the screen door, from the backyard, leading into bedroom #4. LPA observed the screen door had dirt & grime. (Photographs were taken.) 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 70 degrees F, and hot water temperature was measured at 111 degrees F in resident bathrooms. Fire extinguisher was serviced in December 24, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. ADM stated she does not have a fire drill log. Page 1 Out of 3. LPA reviewed facility records for 3 residents. LPA requested to review R1-R3's preadmission appraisal. ADM was unable to provide LPA with a copy to review. LPA requested to review R3's needs and Services plan. ADM stated she has not completed R3's Needs and Services Plan. LPA requested to review R1-R3's Consent form, (LIC627C). ADM was unable to provide LPA with a copy to review. LPA requested to review R1-R3's Personal rights of Residents in publicly operated residential care facilities for the elderly (LIC613C), ADM was unable to provide LPA with a copy to review. LPA requested to review R1-R3's Resident Personal Property & Valuables form, (LIC621). ADM stated she has not filled out this form for R1-R3. LPA requested to review R2-R3's ID and Emergency information form ( LIC601). ADM was unable to provide LPA with a copy to review. LPA reviewed facility records for 2 staff. LPA requested to review S1's training records and first aid training. ADM stated S1 has not completed his/her training for 2024 or his/her first aid training either. LPA requested to review S1's SOC341A. ADM was unable to provide S1's SOC341A form. LPA requested to review ADM's documents. ADM stated she has the completed all the required documents but has them on her computer. ADM stated her printer does not work. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing R1's centrally stored medication log, LPA observed the log did not have start dates for 5 medications. (Photograph taken.) While reviewing R3's Medications, LPA observed medication M1 was not listed on the Centrally stored medication log. (Photograph taken.). LPA conducted interviews with 1 staff and 2 residents. During today's visit, LPA followed up on the case management conducted on 7/22/2024. LPA Rai was investigating R4's death at the facility, and was not in hospice services. Based on R4's death certificate, R4's cause of death was probable complication of an existing health condition. LPA provided ADM with a flyer "Important updates to Dementia Care & Miscellaneous Changes, Effective January 1, 2025." Page 2 Out of 3. LPA requested a copy of the following documents: 1.LIC 500, Personnel Summary 2.LIC 308, Designation of Administrative Responsibility 3.LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. Qualifications of Administrator (Certificate) 6. Copy of surety bond 7. Please review your facility program for updates (incorporating new laws and/or regulations) Deficiencies are being cited during today's visit. This report was reviewed with Administrator Dhorydell Sison and a copy of the signed report was provided. Page 3 Out of 3. END OF REPORT.the state’s words, verbatim · CDSS document, Dec 26, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to follow up on the Death Repot for resident R1 who was not on Hospice services. LPA Rai met with Lead Staff, Leslie Manalo and stated the purpose of the visit. LPA Rai spoke with Administrator (ADM) Dhorydell Sison over the phone and stated the purpose of the visit. During visit, LPA Rai obtained the following copies to include but not limited to R1's Admission Agreement, R1's Physician's Report, and R1's After-Visit Summary from recent hospitalization. ADM stated to submit R1's Appraisal/Needs and Services Plan and R1's Death Report to LPA Rai via email as soon as possible. ADM will provide a copy of R1's Death Certificate once it becomes available. LPA Rai determined this case management needs further investigation. This report was reviewed with Lead Staff, Leslie Manalo and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 22, 2024