Shamrock Residential Care Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Marcella Tarin and Coryse Ngangmenyi conducted an unannounced annual inspection and met with Licensee/ Administrator (ADM) Vicky Ablao. LPA stated the purpose of the visit. LPAs toured the interior and exterior of the facility with Licensee/ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPAs observed the refrigerator thermostat temperature at 30 F and Freezer at -10 F. LPAs observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 7/22/2026. LPAa reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was on 7/10/2026. Page 1 of 2 LPAs toured 4 resident rooms. All 4 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPAs toured 3 resident bathrooms. All 3 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPAs measured water temperature with a range of 108.8 F to 117.1 F. LPAs reviewed 3 resident records. LPAs reviewed 3 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPAs reviewed 3 staff records. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Licensee/Administrator Vicky Ablao and a signed copy of this report was provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Aug 6, 2026

Allegation investigated: Staff financially abused resident in care. Staff did not provide resident with a copy of the Admission Agreement.

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct the initial complaint investigation visit. LPA met with Licensee (LIC) Vicky Ablao. LPA stated the purpose of the visit. On 11/25/2025 the Department received a complaint with the above allegations. On 11/25/2025, LPA Tarin interviewed the Reporting Party (RP). RP states he/she spoke with Resident R1, referred to as R1, on 11/18/2025 and R1 stated he/she had moved into the facility and had wire transferred $15,500 to the facility. RP stated he/she did not have any documentation of the wire transfer in the amount of $15,500. RP stated R1 also stated he/she was not provided an Admission Agreement when he/she moved into the facility on 11/18/2025. RP stated he/she did not have any additional details regarding the transaction or the admission agreement. Page 1 of 2 Unfounded On 12/1/2025 LPA Tarin interviewed R1. R1 states he/she did not know how long he/she lived at the facility, stating "I think it was about 2 weeks ago." R1 stated he/she remembers signing the Admission Agreement and 'went willingly with the Administrator to the bank and I knew it was so that I could live here (facility)." R1 states he/she is responsible for his/her own money. R1 stated he/she did not have bank records or do online banking. R1 stated he/she goes into the bank to conduct all his/her finances. R1 showed LPA an envelope that contained the Admission Agreement dated and signed on 11/18/2025. On 12/1/2025 LPA interviewed Licensee (LIC). LIC states R1 moved into the facility on 11/18/2025 and signed the facility agreement. LIC states R1 handles his/her own fiances. LIC states he/she was not aware of any financial abuse of R1 since moving into the facility. LIC states R1 is current with his/her facility payments through 12/2/2025. Review of R1's Admission Agreement, R1 signed the Admission Agreement on 11/18/2025, agreeing to $300 a day for 15 days, totaling $4,500. LPA also reviewed an invoice dated 11/18/2025 for R1 in the amount of $4,500 for 11/18/2025 to 12/2/2025 (15 days), and a payment made by R1 by 'Chase Counter Check' on 11/19/2025. Review of R1's Physician's Report dated 11/18/2025, R1 does not have neurocognitive disorder. This agency has investigated the complaint alleging staff financially abused resident in care, and staff did not provide resident with a copy of the Admission Agreement. We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Page 2 of 2. END OF REPORTthe state’s words, verbatim · CDSS document, Dec 1, 2025 · control 26-AS-20251125121111

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Vicky Ablao. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature at 20F and Freezer at -10F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 5/16/2025. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed, drills are being conducted quarterly. The facility's last drill was on 7/14/2025. LPA toured 4 resident rooms. All 4 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. Page 1 of 2 LPA toured 2 resident bathrooms. All 2 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range from 110.4F to 119.3F. LPA reviewed 2 resident records. Resident records included current physician's report and service plans. LPA reviewed 2 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 2 staff records. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record, and staff training. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator Vicky Ablao and a signed copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 14, 2025

Type of visit: Required - 1 Year

On 8/8/2024 at 9:15 a.m. Licensing Program Analysts (LPAs) Marcella Tarin & Maria (Mita) Partoza conducted an unannounced required 1 year Inspection and LPA was greeted by staff upon arrival. Licensee/Administrator, Vicky Ablao arrived shortly thereafter. LPAs stated the purpose of the visit. The facility is an Residential Care Facility serving adults from 60 and over and has hospice wavier for 5, and capacity of 6. At 9:15 a.m. LPAs toured the facility inside and out. Four residents were present and engaged in various activities. The temperature inside the home was at a comfortable 73 degrees F. Residents bedrooms were observed to be sanitary, organized with sufficient storage for resident's personal belongings. LPAs observed working auditory alarm system for each resident's emergency exit doors. Bathrooms were observed to be clean, with grab bars, toilet papers and non-skid mats. Hot water temperature was measured 107.4 degrees F. Living room and activity area, kitchen and dining area were observed to be in order. Cleaning supplies, toxic and sharp objects are secured and inaccessible to residents. 7 days of non-Perishable and 2 days of perishable food supplies were observed. Smoke alarms, carbon monoxide detectors were observed to be in good working condition. The fire extinguishers was last inspected on 3/8/2024. The facility has first aid kit that are accessible to staff. Medications were stored in a locked medication cart. At 10:15 a.m. LPAs discussed with administrator (ADM) maintenance and housekeeping such as changing the bathroom shower liner that was observed to have black residue at the bottom and the cabinet door to the right was loose/coming off the hinge. LPAs observed part of a wooden ramp that has loose planks and loose hand rail posts, which are are not secured to the bottom of the ramp (ramp is located on the exterior of bedroom #1) . LPAs observed missing grout between tiles on the kitchen counter next to the sink where food is prepared, food particles were stuck in between the spaces that could contaminate food served. page 1 of 2 see LIC 809C Staff records were reviewed to be complete and current with CPR/first aid, clearances and training. Residents records, medications are labeled and log on the Centrally Stored Medication & Destruction Record (CSMDR). Emergency drill is conducted on 1/2024, 4/2024 & 7/2024. ADM stated that fire inspection is conducted yearly to assess the fire sprinkler installed in the facility. The sprinklers were tested on 8/28/2023. Deficiencies are cited during today's visit based on California Code of Regulations (CCR) Title 22. See LIC 809D. An exit interview was conducted with ADM Vicky Ablao. A copy of the report and appeals rights were provided. LPAs requested for the following documents and were provided by the administrator. LIC 500, LIC 308, updated copy of administrator certificate and resident roster. A copy of the liability insurance and the lease agreement. End of report, Page 2 of 2.the state’s words, verbatim · CDSS document, Aug 8, 2024