Sterling Senior Community VI

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Daisy Justo. Administrator (AD) Sheryl Tongol arrived shortly after. For today’s visit, LPA observed a total of six residents in care and two staff members on duty. LPA observed the facility Administrator (AD) certificate for AD Sheryl Tongol which expires on December 19, 2027. LPA observed that the PUB475 "See Something, Say Something" poster was posted by the entryway. LPA Ramirez toured the interior and exterior portions of the facility with AD Tongol. The facility is a one story home and is licensed for six non-ambulatory, of which one may be bedridden. The facility has a hospice waiver for six. There are a total of five resident bedrooms and one staff bedroom. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and were kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of two restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 111.5-117.5 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged and located by the bedrooms' hallway and by the kitchen. The fire extinguishers were last serviced on May 19, 2026. CONTINUED ON LIC809-C... LPA Ramirez observed the emergency disaster and evacuation plan, which is located by the entryway. Licensee was advised to use the updated Emergency Distaste Plan (LIC610E) version dated December 2025. Facility had back-up emergency food and water supply. LPA observed that the First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. The medications are locked in a closet next to the staff's bedroom. For the exterior portion, LPA Ramirez observed a shaded area, patio furniture, and the grounds were free of any hazards. There is one gate in the backyard, which is both self-closing and self-latching. No bodies of water were observed. During today's visit LPA observed the residents having breakfast, watching television and/or doing physical therapy. LPA reviewed six resident files and three staff files. LPA interviewed residents and staff present. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Tongol. A copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Aug 28, 2026

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

On August 19, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit Administrator (AD) Sherly Tongol was notified via telephone but could not arrive to assist with the inspection. LPA observed that Sherly Tongol has a valid Administrator certificate which expires on December 19, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for six. The facility is a single story home with six private resident bedrooms, one staff bedroom, two shared resident bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA, accompanied by a care giving staff, conducted a tour of the interior portions of the facility. On today's visit, LPA observed six resident in care and two care giving staff present. LPA observed residents watching TV in the living room. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all six resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 113 and 115.7 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. CONTINUED ON LIC809-C LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a separate locked kitchen cabinet under the sink. LPA observed fire extinguishers to be mounted on the wall by the entryway of the facility, in the living room, in the kitchen, and in the unattached two car garage. LPA observed fire extinguishers to be charged and serviced as of October 8, 2024. LPA tested the individual smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on May 24, 2025. LPA observed the centrally stored medication to be kept in a locked cabinet by the staff bedroom. LPA observed the facility has a First Aid Kit stored in the locked cabinet and it had all the required components. LPA, accompanied by a care giving staff, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gate of the facility to be self latching and can be opened in an evacuation. LPA inspected the unattached two car garage. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. There are no bodies of water on the premises. LPA reviewed all six resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPA reviewed three staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with an authorized facility representative and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Daisy Justo. Administrator (AD) Kian Pascual arrived shortly after. For today’s visit, LPA observed a total of four residents in care and two staff members on duty. LPA observed the Administrator's Certificate for Kian Pascual which expired on 05/24/24, however, AD provided proof of payment to show that the certificate is in renewal process. Renewed certificate has not yet been received and is pending. LPA reminded Licensee to post certificate once received. LPA Ramirez toured the interior and exterior portions of the facility with caregiver Justo. The facility is a single level structure and is licensed for six non-ambulatory residents, of which four may be on hospice and one bedridden. There are a total of six bedrooms, of which five are resident bedrooms, and one private bedroom for staff. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of two restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 110.6-114.6 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged and one was located by the dining room/living room, two in the kitchen, one by the main entrance and one in the garage. CONTINUED ON LIC809-C.. AD to print and post the emergency disaster and evacuation plan. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. For the exterior portion, LPA Ramirez observed a shaded area, patio furniture, and the grounds were free of any hazards. There is one gate in the backyard. No bodies of water were observed. LPA reviewed four resident files and two staff files. LPA interviewed residents and staff present. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Pascual. A copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Aug 23, 2024

Allegation investigated: Facility staff failed to properly administer resident’s medications. Facility failed to maintain a complete and accurate resident’s records. Facility failed to maintain a complete and accurate staff records.

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on 12/11/23. LPA was greeted and granted entry into the facility and met with Caregiver Daisy Justo. LPA explained the reason for the visit. This agency has investigated the complaint alleging that facility staff failed to properly administer resident’s medications. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: One of five individuals interviewed confirmed the allegation. During the investigation LPA reviewed documents including the Medication Administration Record (MAR) dated December 2023 for Resident 1 (R1) and R2. Per MAR staff are properly administering R1's and R2's medications. During the course of the interviews with residents R1 reported that staff manage their medications properly and stated that staff are attentive. CONTINUED ON LIC9099-C... Unfounded Regarding the allegation that facility failed to maintain a complete and accurate resident’s records, the investigation revealed the following: During the investigation LPA reviewed documents including the Sterling Senior Community 6 Register of Facility Residents (LIC9020A). LPA observed that the Register of Facility Residents was completed in all required sections which include Room Identifier, Resident Name and Language, Ambulatory Status, Physician contact information and Representative contact information. LPA reviewed documents including the Resident Appraisal for R3 and R4. LPA observed that all sections of Resident Appraisal for R3 and R4 were completed, dated and signed. Regarding the allegation that facility failed to maintain a complete and accurate staff records, the investigation revealed the following: LPA reviewed documents including the Health Screening Report - Facility Personnel (LIC503) for Staff 1 (S1) dated 04/04/23 and for S2 dated 04/07/23. LPA observed that all sections on the Health Screening Report - Facility Personnel for S1 and S2 were completed, dated and signed. LPA also reviewed S1 and S2 files and observed that the files included the Personnel Report (LIC501), results for negative Tuberculosis test, Criminal Record Statement and Out -Of-State Disclosure, Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders, and Notice of Employee Rights. Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or are without a reasonable basis. LPA Ramirez conducted an exit interview with facility representative, and a copy of this report was provided to the facility. Based on LPA's observation and information gathered during the investigation, 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, the allegation is deemed UNSUBSTANTIATED. LPA Ramirez conducted an exit interview with facility representative, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 22-AS-20231211124014

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Caregiver Daisy Justo. LPA explained the reason for the visit. On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: One of five individuals interviewed corroborated the allegation. During the initial visit on 12/14/23 LPA toured the facility, LPA observed and took pictures of a chair in the dining room, the kitchen floor tile, the kitchen pantry and hallway restroom door and baseboard. In the dining room LPA observed that the chair cover was ripped exposing the chair inner cushion. At 1:34 PM LPA observed that the kitchen's pantry paint is chipped and has black discoloration. At 1:36 PM LPA observed that the kitchen floor tile below the knives' cabinet is broken and has brown and black discoloration. CONTINUED ON LIC9099-C... Substantiated In the hallway restroom LPA observed that the entrance door and baseboard next to the shower have chipped paint, black discoloration and/or are scraped. At 2:28 PM LPA observed that the base of the railing leading to the back yard has chipped paint, is scraped and rusted. Based on LPA's observation and information gathered during the investigation, the preponderance of evidence standard has been met, therefore the following allegation: facility is in disrepair is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with staff Pascual and a copy of this report and the Appeal Rights were provided at the time of this visit.the state’s words, verbatim · CDSS document, Dec 14, 2023 · control 22-AS-20231211124014

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 8, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: During the 10-Day complaint visit LPA observed that the kitchen tile, pantry, yard railing and hallway restroom and door have chipped paint, are scraped, have black discoloration and/or are rusted. LPA also observed a dining room chair with a ripped cover exposing the chair inner cushion.the state’s words, verbatim · CDSS document, Dec 14, 2023

Plan of correction: Licensee to provide pictures of repaired kitchen tile, pantry, yard railing, hallway restroom and baseboard and dining room chair by POC due date.

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.