Tayaba's Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Roman conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee, Josephine Tayaba. According to the facility’s license, the facility has a maximum capacity of six clients, of whom all may be non-ambulatory and has a hospice waiver approved for six clients. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas. Water temperature was measured at 140 degrees F. Licensee reported to inform maintenance worker to fix hot water temperature between 105-120 degrees F. No pools or bodies of water on the premises. Per Josephine Tayaba, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present. First aid kit was complete and readily accessible. Resident records reviewed had required documentation. Staff records reviewed contained required documentation, although needed to be update to reflect one staff health record. An exit interview was conducted with Licensee, Josephine Tayaba, to whom a copy of this report and the Licensee/Appeal Rights, were provided during the visit.the state’s words, verbatim · CDSS document, Feb 23, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced Case Management - Other visit. LPA was greeted and allowed entry into the facility by Licensee, Josephine Tayaba. Today's visit was regarding a fire clearance request submitted to the San Diego Fire Prevention Authority requesting a change in Non-Ambulatory status. On 06/13/25, the San Diego Fire Prevention Authority approved all bedrooms for Non-ambulatory use, exits from bedrooms must be kept clear at all times. During the tour of the facility on 06/27/25, it was discovered a resident was residing in bedroom #3, which was a staff bedroom, not approved for resident use. The licensee was issued a deficiency along with a civil penalty. The licensee was made aware the civil penalty will be ongoing until corrected. The licensee agreed to relocate the resident to an approved non-ambulatory room. Today, LPA verified the resident is now residing in an approved resident room. The licensee provided proof via photo with date stamp and time that the resident was relocated as of 06/29/25. In addition, the licensee submitted a new facility sketch to reflect room #2 will now be a staff room and all other rooms will be resident rooms. The civil penalty has ceased. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Josephine Tayaba whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jul 7, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced Case Management - Other visit. LPA was greeted and allowed entry into the facility by Licensee, Josephine Tayaba. Today's visit was regarding a fire clearance request submitted to the the San Diego Fire Prevention Authority requesting a change in Non-Ambulatory status. On 06/13/25, the San Diego Fire Prevention Authority approved all bedrooms for Non-ambulatory use, exits from bedrooms must be kept clear at all times. The facility is now licensed for six (6) Non-Ambulatory residents. During the tour of the facility, a resident was residing in bedroom #3, which was a staff bedroom, not approved for resident use. The licensee explained they spoke with the Fire Marshall and assumed it was okay to move the resident to a staff bedroom. LPA requested the resident in bedroom #3 be moved to an approved non-ambulatory resident room. However, the licensee stated they needed time to relocate the resident to an approved room. In addition, the licensee stated they will be making more changes to the facility regarding staff and resident bedrooms. The licensee was instructed to submit a new facility sketch. Today, a civil penalty was assessed for a fire clearance violation. The licensee was made aware the civil penalty will be ongoing until the resident is relocated to the appropriate room. There were no health or safety concerns identified during the visit. A deficiency was issued, along with a civil penalty. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Josephine Tayaba whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jun 27, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jun 28, 2025

All facilities shall maintain a fire clearance approved by the city...or the State Fire Marshal. Prior to accepting or retaining...shall notify the licensing agency and obtain an appropriate fire clearance approved by...or the State Fire Marshal. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with their fire clearance for 1 out of 3 [R1] residents by allowing R1 to reside in an approved staff bedroom, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 27, 2025

Plan of correction: Licensee stated the resident will be relocated to an approved resident bedroom. Licensee stated a photo will be sent once the resident has been relocated. A civil penalty was assessed and will be ongoing until corrected.

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Natasha Persaud conducted an announced second Prelicensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 06/05/24. The facility was approved to care for six (6) Elderly Residents; four (4) Non-Ambulatory and two (2) Ambulatory. The purpose of the visit was to inspect items that required completion on the first prelicensing inspection was on 12/20/24. LPA was greeted and allowed entry into the facility by and met with Applicant, Josephine Tayaba. Structure- The facility is a single story structure with 5 bedrooms and 2 bathrooms. No bodies of water were observed. There is also an Additional Dwelling Unit behind the facility with a separate entrance. Bedrooms Residents- Rooms #1 and #5 may be used for Non-Ambulatory; Rooms #2-#4 ambulatory use. Bedrooms Staff- Room #3 is for staff use only. Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies- Adequate supply. Emergency Phone Numbers, Exit Plan and Required Postings- Posted. Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired. Appliances- Stove burners, oven, microwave, washer, and dryer working. Toxins- Stored in a locked cabinet. Water Temperature- Measured at 117 degrees F. Medications- Centrally stored and locked in a cabinet. First-Aid Kit- Stored in a locked cabinet. Resident & Staff Files- Stored in locked cabinet. Activities- Adequate supplies board games, puzzles, and magazine's for resident's use. Fire clearance- Approved on 09/23/24. Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Prelicensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Applicant, Josephine Tayaba whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jan 3, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Natasha Persaud conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to the Applicant, Josephine Tayaba. During today’s visit, LPA, accompanied by the applicant, toured the interior and exterior of the facility and inspected each room. There are items which must be corrected for the facility to comply with regulation(s). The applicant did not pass the pre-licensing inspection, and a return visit will be required. An exit interview was conducted with the Applicant, Josephine Tayaba to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Dec 20, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Tayaba, Josephine N. On 11/13/24, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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, Nov 13, 2024