Summerland Manor

Type of visit: Required - 1 Year

On 07/23/26, at 9:20am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annually required inspection visit to Summerland Manor. LPA was met by Bienvenido Cadungog, Administrator, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) elderly residents aged 60 and above, five (5) of which may be non-ambulatory and one (1) bedridden. Approved for one (1) hospice resident. Currently the facility has (4) residents. The facility’s annual fees are current. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) bedrooms, one (1) staff room, two (2) common bathrooms, living area, dining area, kitchen, attached garage, and an outside patio area. At 9:40am, LPA and staff toured the facility. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, and adequate storage for resident personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew, there was adequate lighting, and sufficient toiletries were accessible to clients. The water temperature measured 117.2F degrees. A comfortable temperature is maintained in the facility. Report Continued On LIC809-C LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there is enough perishable and non-perishable food available for the residents. All food items were stored properly. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked with manual. The fire extinguishers were charged and last Inspected on 10/29/2025. The smoke/ carbon monoxide detectors were operable. The last fire/emergency drill was conducted on 04/07/2026. The facility’s administrator’s certificate (7006800740) was valid from 3/12/2025 through 3/11/2027. The facility’s liability insurance was valid from 10/07/2025 through 10/27/2026. LPA conducted a review of (4) resident records, (3) staff records, and reviewed the facility disaster plan. Staff records were complete with required documents and training. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (4) resident medication administration records, and medication, and did not observe any discrepancies at the time of visit. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that sanitizing stations were in common areas and restrooms. LPA observed that the facility had the required postings, posted throughout the facility. LPA advised the facility to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues. No deficiencies were cited during this inspection visit. An exit interview was held, and a copy of this Facility Evaluation Report was provided to Bienvenido Cadungog, Administrator.the state’s words, verbatim · CDSS document, Jul 23, 2026

Type of visit: Required - 1 Year

On 06/19/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator, Bienvenido ‘Bien’ Cadungog, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) elderly residents ages 60 and above, five (5) of which may be non-ambulatory and one (1) bedridden. The facility has an approved hospice waiver for three (3) residents. There are currently one (1) resident receiving hospice services. Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident room, staff room, two (2) common bathrooms, living area, dining area, kitchen, attached garage, and an outside patio area. LPA inspected the facility with Administrator. LPA did not observe any bodies of water on the premises. All walkways around the facility were observed clean, clear, and free of obstructions, hazards, and debris. Bedrooms LPA inspected all resident rooms and observed them to be clean and in good repair. LPA observed all rooms have the required items including a bed, dresser, chair, nightstand, and storage space for resident’s personal belongings. All beds were observed with the required linens including a mattress cover, fitted sheets, blankets, comforter, and pillows. LPA observed an ample supply of bed linens in good repair. All bedrooms were observed with adequate lighting. Bathrooms LPA inspected all bathrooms and observed them to be within Title 22 regulations and were clean and operational. LPA observed all safety handrails are secured, and showers have nonskid mats and shower chairs. LPA observed an ample supply of bath towels stocked during the time of the visit. LPA observed an ample supply of hygiene products stored and inaccessible to residents. The water temperature measured 105.6-degrees and 105.7-degrees Fahrenheit. Kitchen LPA inspected the kitchen and observed it to be clean and sanitary. All appliances are operable and in good repair. LPA observed an ample supply of cookware, dining ware, and cutleries in good repair. LPA observed a 3-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored. LPA observed cleaning supplies secured in a cabinet under the kitchen sink and are inaccessible to residents. Sharps and knives are secured in a locked drawer and are in accessible to residents. The water temperature measured 106.4-degrees Fahrenheit. Common Areas LPA observed the dining room has a large table with chairs to accommodate all residents. LPA observed in the living room are two (2) large couches and two (2) chairs available for resident use. The facility was observed to be sanitary and appropriately furnished at the time of visit. LPA observed reading material, games, and activities available for residents. LPA observed the fireplace is screened and inaccessible to residents. All walkways and hallways in the facility were observed clean, clear, and free of obstructions and hazards. All rooms and hallways were observed with ample lighting. The facility was maintained at a comfortable temperature. Medications LPA observed medications secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA observed medication in their original packaging. LPA reviewed the medication and Medication Administration Record (MAR) for four (4) residents. LPA observed four (4) out of four (4) resident’s medications are consistent with properly documented records. Files LPA observed resident files are secured in locked cabinet and are inaccessible to residents and visitor. LPa reviewed the files for four (4) residents. LPA observed four (4) out of four (4) residents files contain the required documents. LPA reviewed the files for the Administrator and two (2) caregivers. LPA observed they had the required documents, certification, and training. The Administrator’s certificate is valid till 03/11/2027. LPA observed during file review the facilities Licensing Fees are current. Safety LPA observed smoke and carbon monoxide detectors are operable. LPA observed two (2) fully charged fire extinguishers lasted serviced on 10/22/2024. The last fire prevention was conducted by the Torrance Fire Department on 02/11/2025. The last emergency drill was conducted 04/11/2025. LPA reviewed the facility’s liability insurance through South Bay Acceptance Corporation that is valid till 09/19/2025. LPA reviewed the Emergency and Disaster Plan for Residential Care Facilities for the Elderly (LIC610E) that was last updated on 03/01/2025. LPA inspected the First Aid kit and observed it contained the required items and a current manual. The facility has an operational landline telephone. All exits are marked with an EXIT sign. All doors have an alarm that chimes when a door exiting the facility is opened. LPA observed all required postings posted in the hallway and dining room of the facility. Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the entrance of the facility that has a visitor log, hand sanitizer, thermometer, and masks. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA observed all required infection control signs were posted in the facility. LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Bienvenido Cadungog, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 19, 2025

Type of visit: Required - 1 Year

On 06/13/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Bienvenido Cadungog and explained the purpose of today’s visit. The facility is licensed to operate for six (6) elderly residents (5) non-ambulatory of which one (1) may be bedridden ages 60 and above. The facility is approved for (3) hospice residents. Currently, the facility has (2) residents in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, and an outside patio area. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 110.6 degree F. A comfortable temperature of 72 degree F was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguisher were charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. The facility has conducted a disaster drill on 12/20/23. A landline telephone was in working condition. A review of staff CPR/First Aid training is current. Evaluation Report Continues LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The facility has current liability insurance on file effective 10/07/23 - 10/07/24. The facility is current on Community Care Licensing annual dues. The facility has a current Administrator Certificate for Bienvenido M Cadungog #6022241740 Exp. 03/11/2025 An audit of residents #1-#3 (R1-R3) service files and staff #1-#4 (S1-S4) personnel files revealed to be complete. Deficiencies: During inspection, LPA identified the facility has not conducted quarterly Emergency Drills. The last fire drill was on 12/20/23. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D). An exit interview conducted with Bienvenido Cadungog and a copy of report and appeal rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *the state’s words, verbatim · CDSS document, Jun 13, 2024

Type of visit: Required - 1 Year

On 10/10/2023 Licensing Program Analyst (LPA), David España conducted an unannounced visit to Summerland Manor. The purpose of today’s visit was to conduct a 1-year annual Inspection. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct the inspection. LPA verified that the facility has an approved mitigation plan report. LPA met with caregivers (S2) Estelita Mariano Fulgueras, (S3) Wenceslao Fulgueras, and Administrator/Manage, Bienvenido M. Cadungog (S1). Four (4) clients and three (3) staff were present during this inspection. This facility is licensed to serve six (6) elderly residents ages 60+, fire cleared for five (5) non-ambulatory and one (1) bedridden for room #4, facility is licensed to serve one (1) hospice resident and is 87705, with an approved hospice waiver for three (3) residents as of 11/21/2012. The Annual Licensing Fees are current. The home is in a residential neighborhood with four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, one (1) living room, one (1) dining room, one (1) kitchen and 1 attached garage. LPA toured with S1 inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. At 8:15 AM LPA observed that both exterior backyard exits were locked, the north exits was locked from the outside using a wooden latch from the outside and the south exit was locked by a nail inserted to the gate latch. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. At 8:45 AM LPA observed full bed rails on 4 out of 4 residents (R1, R2, R3 and R4) beds. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secured, showers were free of mold/mildew and non-skid mats were in place, hot water temperature properly measured at 116 degrees Fahrenheit. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions.There are no security bars or weapons on the premises.LPA toured the kitchen area and observed a two-day (2) supply of perishable and a seven-day (7) supply of non-perishable food. Knives and toxics were kept in locked storage cabinets. See LIC 809-C on the next page First Aid kit was available. One fire extinguisher last serviced 11/22/2022 was observed near the rear exit in the kitchen area. LPA tested one carbon monoxide detector and one smoke detector located in the hallway area. Both devices were functional. LPA observed that all bedrooms and hallways are equipped with a carbon monoxide and smoke detectors. LPA also observed 1 out of 4 residents (R4) being secured to their wheelchair by caregiver S2 using a “safety band” on R2 Licensee verified that “safety band” has been approved by doctor for the safety and does not tie down resident it permits quick release by the residents. At 9:40 AM LPA did not observe an updated Administrators Certificate, licensee stated that they are in the process of obtaining certificate. 4 staff records were reviewed, 4 out of 4 staff records did not have current first aid certificates. 4 resident records were reviewed and 4 out of 4 residents (R1, R2, R3 and R4) did have signed Admission Agreements, 4 out of 4 residents had updated Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. Deficiencies are being cited based on LPA observations, interviews conducted and record reviews in accordance with the California Code of Regulations (CCR), Title 22. Two (2) Type B Deficiencies were cited: Staffing - Type B: 1569.618(c)(3) - Personnel Records/Staff Training - Type B: 87412(d) Two (2) Technical Violation were issued: Personnel Records/Staff Training - Technical Violation: 1569.625(b)(2) Personnel Records/Staff Training - Technical Violation: 87411(c)(1) Two (2) Technical Assistance were issued: Personnel Records/Staff Training - Technical Assistance: 1569.626(a)(2) Resident Rights/Information - Technical Assistance: 87468(c)(2)(A) An exit interview was conducted, and a hard copy was provided with appeal rights to Administrator/Manage, Bienvenido M. Cadungog (S1). See LIC 809-D on the next pagethe state’s words, verbatim · CDSS document, Oct 10, 2023

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.