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Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christina Valerio and Reza Jamaly arrived unannounced to conduct a case management visit. LPAs met with facility staff Rex Calma, and explained the purpose of the visit. LPAs was later met by licensee Laila Dungca. On 03/05/2026, facility staff Sarah Egante sent an incident report for Resident 1 (R1). The incident report stated that on 03/03/2026 at 3:30 PM, R1 was being picked up by R1's friend due to a eye appointment. The facility supervisor reached out to R1 via cell phone at 8:30 PM - 9:00 PM, but R1 did not answer. Since R1 did not return to the facility on 03/04/2026, the facility filed a missing persons report with the local police department. LPAs reviewed the facility file for R1. R1 is unable to leave the facility unassisted, is able to communicate, is able to follow directions/instructions, unable to care for ADLs, and has needs supervision next to all behavioral expressions. Based on the facility file, the resident is responsible for self. According to staff, R1 did not come back to the facility. According to staff, the police notified the facility that on 03/12/2026 they found the resident and the case is closed. According to staff, the resident decided to self discharge and live with their loved one. Based on the information learned on today's visit, no deficiencies are being cited. An exit interview was held with staff Rex, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sommer Hayes arrived unannounced to conduct a Required - 1 Year visit on 10/3/2025 LPA Hayes was met by staff and later met with Designated Facility Representatives, Sarah Jane Egante and Maria Socorro Caldeira and stated the purpose of today’s visit. The facility is licensed for a capacity of 6. The census was 6. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The most recent emergency drill was conducted on 09/2/25 at 1:00 pm with 6 residents. The temperature inside the facility was observed to be at 78*F, which is within the required range of 68-85*F. The hot water temperature was measured at 106.5 *F which is within the required range of 105-120*F. LPA observed fire extinguisher serviced 12/11/24 by River City Fire. Smoke and carbon monoxide detectors, and central heating and air were observed in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. Staff were observed cooking, cleaning and assisting residents in care. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA Hayes observed the backyard of the facility to be clean and free of hazards. There were shaded areas for residents to enjoy. Fencing was in good repair. There were no bodies of water. The facility living room was clean and free of obstruction. Continued on 809-Cthe state’s words, verbatim · CDSS document, Oct 3, 2025

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 9/17/2025 Licensing Program Analysts (LPAs) Sommer Hayes and Arvin Villanueva arrived unannounced to this facility to conduct a case management visit for the purpose of delivering an Order to Licensee/Facility of Immediate Exclusion from all facilities. LPAs was met by staff 2 (S2) and explained the purpose of this visit.. The Administrator Laila Dungca was not present at the facility. LPAs tried to contact the Licensee via phone and was not available. Staff 1 (S1) is excluded as a result related to this facility. LPAs served notice of "ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY" to staff for S1 who was not present at the time of visit. Facility was advised to hire a new Administrator to replace S1 as the Administrator and submit necessary documents to Community Care Licensing. Staff was advised that an immediate removal is warranted and requested the Personnel Report (LIC500) and Guardian account be updated to remove S1 from the facility staff roster. A notice of completion shall be submitted to Community Care Licensing (CCL) emailing LPA Sommer Hayes. LPA informed the Administrator that S1 is not allowed to be employed and/or on any facility premises. ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY will be in effect as of 9/17/2025 upon receipt of the letter. continued on 809-C A copy of the letter was given to the facility during this visit. The facility understands this is an Immediate Exclusion and has agreed S1 cannot be allowed to work, live in, and/or have contact with residents in any residential facility licensed by the California Department of Social Services unless otherwise ordered by the Department. Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed and cited. Exit interview held with Jane Egante, and a copy of this report was providedthe state’s words, verbatim · CDSS document, Sep 17, 2025

Type of visit: Case Management - Other

On 10/21/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to this facility to conduct a case management visit. LPA Villanueva met with Administrator Eric Serrano, and stated the purpose of the visit. Present during today's visit were 4 residents in care with 2 staff on duty. During this visit, LPA obtained copy of resident files (R1, R2, R3, and R4), including their Identification and Emergency Information, Pre-Placement Appraisal Information, current Physician Report and current Needs and Services Plan. Per Administrator, current residents are not currently receiving outside agency services. No deficiencies are being cited during today's visit. Exit interview was conducted with Eric Serrano and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 21, 2024

Type of visit: Prelicensing

On 10/18/24 Licensing Program Analyst (LPA) Arvin Villanueva arrived announced to conduct a pre-licensing inspection. LPA Villanueva met with Administrator Eric Serrano and Licensee Laila Dungca, and explained the purpose of the visit. The facility is currently undergoing a Change of Ownership. LPA observed 1 residents in care. LPA learned the residents are scheduled to move out by the end of the month. Eric Serrano will be the designated Administrator. Administrator Certificate # 7023144740, expires on 08/26/26. The facility has an approved fire clearance for six (6) non-ambulatory residents for bedrooms #1, #2, and #3. There is a separate sleeping area designated for staff only located at the second floor of the house. The facility has a granted hospice waiver for three (3). Dementia plan has been submitted. LPA Villanueva reviewed the infection control plan and their emergency disaster plan. Licensee and Administrator has identified the location of their shut off valves. Note this facility does not have shut off valve for gas as it is equipped with solar panel. LPA observed the physical plant to ensure compliance with Title 22. LPA observed the common areas to be cleaned, organized, and free from debris. Areas were observed to be fully furnished. LPA observed resident bedrooms to be equipped with beds, clean linens, a dresser, night stand, closet space, a chair, and a lamp. Resident bathrooms were stocked with hygiene supplies, hand soap, paper towels, a lidded trash can, a non-skid mat, shower chair, non-skid flooring and hand rails. Bathrooms were observed to be clean. Each bedroom is equipped with smoke detectors. Smoke detectors were also observed in the hallway and living room. Carbon monoxide was observed in the resident hallway. They were tested and found operable during this visit. LPA observed second floor (staff room) to have smoke detector. The backyard was observed to have a covered patio area for outdoor activities and equipped with outdoor furniture. Storage shed were observed to be locked. Fence and gates were observed to be in good repair at this time. Emergency exits were clear of obstructions. Medications, sharps, chemicals, and cleaning supplies were observed to be locked and inaccessible to residents in care. LPA observed the files are maintained and available for review. LPA conducted Component III with Licensee Laila Dungca and Administrator Eric Serrano. There were no further questions from either the Licensee or Administrator. The applicant has passed the pre-licensing component of the application process. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 18, 2024

Type of visit: Case Management - Other

On 10/15/24, Licensing Program Analyst (LPA) arrived at this facility unannounced to conduct the Prelicensing visit. LPA met with the Administrator, Eric Serrano, and stated the purpose of the visit. At this time, the Applicant, Laila Dungca, is out of town and not available to conduct this prelicensing. LPA will schedule the visit at a later date with the Applicant to conduct the prelicensing. Exit interview with Eric Serrano and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 15, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 6 Census (if any clients in care): 4 COMP II Participants: Eric Serrano, Administrator Laila Dungca, Applicant Interview Method: Virtual interview (Microsoft Teams) On October 9, 2024 at 11:00 AM, Applicant and 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. During COMP II, CAB analyst confirmed Applicant and 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 Readiness Exit interview conducted with Applicant and Administrator. Report sent via email and informed to return sign copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Oct 9, 2024