Sterling Senior Community 12

Type of visit: Office

Licensing Program Managers (LPM) Kevin Saborit-Guasch and Alisa Ortiz along with Licensing Program Analyst (LPA) Nancy Guillen met with Licensee Albert Pimentel and Michelle Kellogg in regards to concerns with consistency of complaints investigations and also wanted clarification on Title 22. The following were discussed: - Complaint Investigation Process - Expectations of collaboration between LPAs and Licensees - Appeal rights - Title 22 requirements regarding staff training, awake staff, and staff records Licensee expressed intention to continue building rapport with the department An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 21, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Karla Paulo after introducing and stating the reason for the visit. House Manager (HM) Arnold Mendoza and Assistant Caregiver (AC) Kian Pascual are certified administrators. Both maintain a valid certificate expiring on December 6, 2027 for HM and May 26, 2028 for AC. The following was observed during the inspection: This is a single story property located in a residential neighborhood comprised of six resident bedrooms three resident bathrooms, and one private staff bedroom. Facility is not operating within the conditions and limitations specified on the license as Room #2 is approved to house a bedridden resident also noted per the fire clearance. Resident #3 (R3), who is considered bedridden per the physician's report is housed in Room #3 while Resident #2 who is non-ambulatory is housed in Room #2. LPA observed five residents in care, two of which are receiving hospice services. LPA toured the interior portion of the facility. The facility is clean and in good repair. All common areas were inspected including the attached two car garage. LPA inspected all resident bedrooms. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. All bathrooms were found be in compliance, clean, and operational. Slip resistant mats were available. The hot water temperature in the bathrooms measured at 108.5, 109.4, and 110.3 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gates are operational, and there were sufficient seating and shading in the patio area. There are no bodies of water on premise. The first aid kit contains all necessary elements. The three fire extinguishers were mounted, charged, and serviced on February 3, 2026. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Facility maintains emergency food and water. The facility land line number, (714) 916-0099, was tested and remains available. Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the correct size in the entry way. LPA reviewed five of five resident and four of four personnel files in which no discrepancies were found. Medications were audited for two of five residents. No discrepancies were found with medication administration. However, staff were reminded to maintain an accurate record of dosages administered. Present staff are background cleared and associated to the facility. Staff training is up-to-date. Disaster drills are conducted quarterly as last known drill per log was conducted on February 19, 2026. LPA consulted on the following: to ensure that Room #2 is designated to a bedridden resident and to maintain an accurate record of medications administered during the development of the medication administration record app. Based on the observations made during today's visit, a deficiency is being cited and a Technical Violation is being issued. An exit interview was conducted with House Manager Arnold Mendoza, Assistant Caregiver Kian Pascual, and Caregiver Karla Paulo, and a copy of this report including the appeals rights were provided at exit.the state’s words, verbatim · CDSS document, Mar 19, 2026

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.

Allegation investigated: Resident developed an unstageable wound in care

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on January 14, 2025. LPA was greeted and granted entry into the facility and met with Administrator Assistant Arnold Mendoza. LPA explained the reason for the visit. This Department has investigated the complaint alleging that Resident developed an unstageable wound in care. Regarding the allegation the following was revealed: During the investigation LPA reviewed the MemorialCare Orange Coast Medical Center admission facesheet dated January 11, 2025, for Resident 1 (R1). Per admission facesheet R1 was admitted to MemorialCare Orange Coast Medical Center for Renal Failure. Per the mayoclinic.org, Renal Failure occurs when chronic kidney disease, the gradual loss of kidney function reaches an advanced state. LPA reviewed documents including the MemorialCare Hospice and Palliative Care Services Physician's orders dated January 19, 2025, for R1. Per Physician's orders, R1 was admitted to Hospice for Renal Failure. During the course of the interviews with residents, R1 reported CONTINUED ON LIC9099-C... Unsubstantiated that she has not develop wounds while living here. R2 stated that he has not develop an unstable wound. Per R3, she has not developed wounds since moving into this house. During the interviews the Administrator Assistant reported that R1 did not developed an unstable wound while in care. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA conducted an exit interview with Administrator Assistant Mendoza, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 18, 2026 · control 22-AS-20250114150224

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by House Manager (HM) Arnold Mendoza, and LPA Vanegas explained the purpose of the inspection. LPA Vanegas set up equipment and began a tour of the facility and observed the following. This is a one storied home with seven bedrooms one of which is a staff bedroom, and six of which are resident bedrooms. This facility has four bathrooms, and an attached two car garage. LPA Vanegas observed kitchen area to be clean and free of debris and mildew. LPA Vanegas observed there to be a gas stove, microwave, dishwasher, refrigerator, washer, and a dryer. All were in good repair and tested operational. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food, and a sufficient amount of emergency water for residents in care. LPA Vanegas observed all resident rooms to have the required furnishings such as a lamp, chair, enough storage space, a bed, and clean linens in good repair; meaning no strains or tears. Bedrooms are large enough to walk about freely, and no obstructions are blocking entry ways. LPA Vanegas observed all resident bathrooms to be free of any mildew or debris, as well as having all required furnishings such as a shower chair, slip resistant floor matts, and grab bars. Water faucets, and toilets tested operational, and water tested between 112.8 and 113.2 degrees. LPA Vanegas observed outside of the facility to be clean and free of any debris along emergency exit routes. Side gates are self latching and unlocked, there is an outdoor shaded sitting area, and backyard is large enough to participate in outdoor activities upon resident request. CONTINUED ON LIC809C LPA Vanegas observed all toxins, sharps, and medications to be locked away and inaccessible to residents in care. LPA Vanegas observed all fire extinguishers to be up to date, and fully charged. LPA Vanegas observed all smoke detectors to be in good repair and operational. LPA Vanegas observed first aid kit to have all required items such as adhesive tape, tweezers, scissors, bandages, a thermometer, and a first aid manual. LPA Vanegas observed infection control plan, and disaster preparedness plan to be fully up to date, and filled out correctly. LPA Vanegas reviewed centrally stored medications log with HM Arnold Mendoza, and observed for all medications to be documented correctly, and per LPA Vanegas review medications are being administered per physicians orders. LPA Vanegas reviewed two staff files and five resident files all files (staff and resident) had all required documents, and annual staff training was up to date and documented. Based on observations made during today's visit no deficiencies will be issued per title 22 Chapter 8 Division 6 of the California Code Of Regulations. An exit interview was conducted with HM Arnold Mendoza, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 7, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA arrived at the facility and was greeted and granted entry by Michelle Kellogg, Licensee. LPA also met Albert Pimentel, Licensee and Kian Pascual, Employee. An application to operate a Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden residents was received by CCL on 5/10/2023. Structure - The facility is a one-story home with six resident bedrooms, four bathrooms, one staff room, kitchen, dining area, living room, attached two-car garage and backyard. LPA observed facility to be clean, sanitary and safe. Resident Bedrooms/Bathrooms - All resident bedrooms are private with all the necessary furnishings, ample lighting and screened windows. Bedrooms with sliding doors are equipped with alarms. Bedroom 2 has been approved to house the bedridden resident. Hot water initially measured over 120 degrees Fahrenheit. Licensee adjusted the hot water heater. After approximately thirty minutes, LPA measured hot water in resident bathrooms. Hot water measured at 120 degrees Fahrenheit in the bathrooms that share a hallway with the staff room and medication cabinet. Hot water in bathroom nearest to the living room measured at 116.3 degrees Fahrenheit. Hot water in the remaining bathroom measured at 111.2 degrees Fahrenheit. LPA advised facility to maintain a water log since they had to adjust the water during the inspection. Medications, Files, First-Aid Kit will all be stored in cabinets in the hallway. First aid kit has the necessary components. Activities - The facility has a calendar of activities including but not limited to: board games, cooking classes, exercise, arts and crafts, movie nights and more.. Kitchen/Food Service/Emergency Food & Water/Toxins - There is a 7-day supply of non-perishable food on hand. Emergency food supply is located in the garage. Facility ordered 8 gallons water for emergency use. LPA verified the water is scheduled to arrive at the facility on 2/17/2024. LPA observed knives and sharp objects to be locked in a drawer in the kitchen. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to client and will be stored and locked in the garage and under the kitchen sink. LPA noted the toxins stored in the kitchen are stored separate from food and food-handling items. The Fire Clearance, was approved by a fire inspector of Huntington Beach Fire Department on 10/25/2023. All fire extinguishers are fully charged. The service tags indicate they were last serviced on 1/16/2024. LPA observed the smoke/carbon monoxide detectors to be dual detectors. Detectors were tested and observed to be operational. Emergency Phone Numbers, Exit Plan, Activity Calendar & Menu are all posted and available for review. Component III was reviewed and provided via PDF. Comp III provides a general overview of how to maintain compliance in accordance with regulations. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report and Component III presentation were provided to facilitythe state’s words, verbatim · CDSS document, Feb 16, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Jeremias Filio, Administrator & Michelle Kellogg, Licensee Interview Method: Teams Meeting On 12/8/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. 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, Dec 8, 2023