The Estate of Estaban 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:30 A.M. LPA was greeted by the administrator, Estrella (Lillian) Alarcon. Program manager, Allen Alarcon joined the visit at 11:15 A.M. LPA explained the reason for the visit. Entrance interview conducted. Beginning at 11:00 A.M., the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Hardwired combination smoke and carbon monoxide detectors were tested at 12:45 P.M. and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and purchased on 11/06/2025. This facility doesn’t have a designated staff room and provides care on a 24-hours basis. LPA explained to the administrator that the use of surveillance cameras or baby monitors does not substitute for awake or on-duty staff during nighttime hours. BEDROOMS: The facility consists of six (6) bedrooms. Each bedroom has its own bathroom; however, bathroom located in Room #6 will be shared visitors. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. During the inspection, LPA observed that the single ambulatory-designated room (room #6) was occupied by Resident #1(R1), who is currently non-ambulatory. Continued on LIC 809-C Continued from LIC 809 RESTROOMS: The LPA observed five (5) private restrooms and one shared. Resident restrooms are clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Between 12:05 P.M. and 12:21 P.M. hot water temperature was measured in all resident restrooms. All restrooms measured within the required range. COMMON SPACES: These include the Family Room, Living Room and Dining Room. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The LPA observed the required postings in the common area. The facility has a fireplace in the family room. At the time of the visit, LPA observed the fireplace to be properly screened. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The facility maintained a temperature of 72 degrees. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed two working phones available for residents use whenever needed. Facility is equipped with two fire doors to enhance safety and prevent the spread of fire. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. LPA conducted a review of expiration dates on product labels. At 12:24 P.M. hot water was measured at 110.7 degrees Fahrenheit. OUTDOOR SPACE: Garden and yard are easily accessible to residents, and they are sufficient in size, comfortable and appropriately equipped for outdoor use. There was a shaded area with proper furniture for outdoor use. LPA observed two (2) self-closing and latching side gates. LPA observed a non-working creek on the property. At the time of the visit, LPA did not observe water running through the creek. Also, LPA observed an operational water fountain located at the front entrance of the facility. The water fountain was functioning properly at the time of the inspection, and no issues were noted. Additionally, LPA observed video cameras facing the outside of the property. Continued on LIC 809-C Continued from LIC 809-C LAUNDRY ROOM: LPA observed a washer and a dryer machine. Furthermore, LPA observed a locked cabinet where medication will be stored. Additionally, Administrator will use extra cabinets to store facility’s first aid kit, emergency food and water supplies, staff and residents’ files, non-perishable food, and hygiene products. At the time of the visit it was observed a low supply of emergency water available on-site. GARAGE: Adjacent to the laundry area is a garage. LPA observed a recently constructed bathroom and two bedrooms. One bedroom contained one queen-size bed, and the second bedroom contained two twin-size beds. The administrator was unable to provide documentation showing that required city permits and/or Fire Clearance were obtained prior to the construction of the rooms and bathroom. LPA notified the administrator that no individual is permitted to sleep in or occupy the garage area until required permits and fire clearance have been obtain and approved. LPA did not check hot water temperature in the staff restroom. RECORD REVIEW: Starting at 1:05 PM Staff records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, CPR and fingerprint clearance. Five (5) staff files reviewed were complete and contained all required documents. EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to emergency disaster plan are adequate, complete, and updated annually, as required. Emergency drills are conducted quarterly, with the last drill documented on 12/13/2025. During the physical plant tour, LPA observed a bus parked on the property. The administrator stated that the vehicle was purchased to transport residents and staff in the event of an evacuation. LPA requested current vehicle registration and observed that registration status was listed as Planned Non-Operation. LPA explained that the vehicle may not be operated or used for transportation until valid registration is issued. The administration stated that the facility has other vehicles with valid registration that are available and ready for use in the event of an emergency. Technical Violation (TV) issued. Continued on LIC 809-C Continued from LIC 809-C During today's visit, LPA gathered the following items: Personnel Records (LIC 500), Current certificate of insurance, Resident Rooster (LIC 9020). Due to time constraints LPA will return at a later date to conduct medication audit and review resident records. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. An immediate civil penalty of $500 is assessed, due to a violation of fire clearance. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Valeria Conway conducted an announced Pre-Licensing Inspection to the above listed facility. Upon arrival LPA met with Administrator, Estrella “Lillian” Alarcon. Entrance interview conducted. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 08/30/2024. A Fire Clearance was approved on 12/02/2024, however further clarification is need it regarding capacity designation. This pending facility has a dementia care program and a pending hospice care waiver for 6 (six) residents. The proposed physical plant is a one (1) story single family dwelling located in a residential neighborhood of Camarillo, CA. This facility will be housing residents with dementia. There are no client residing in the facility at the moment. This facility doesn’t have a staff room, facility will provide 24/7 care. Administrator will provide an updated facility sketch (LIC 999) changing floor plan to reflect “garage” instead of “staff room”. The facility consists of six (6) bedrooms. Each bedroom has its own bathroom; however, bathroom located in Room #6 will be shared with staff and visitors. At the time of the visit, LPA informed Administrator that a door is required to separate the bedroom in Room #6 from the shared bathroom. This measure is necessary to ensure the privacy of residents occupying the bedroom. LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. Continued on LIC 809-C Continued from LIC 809 Fire extinguisher is fully charged and recently purchased. Administrator will submit proof of purchase to LPA. Fire alarms/carbon monoxide detectors were tested at 12:37 P.M. and were functional at the time of the visit. LPA observed all required postings on the facility wall, a revised Emergency and Disaster Plan and a Plan of Operation in use. At 10:30 A.M. a tour of the physical plant was conducted and the following observed: BEDROOMS: There are six (6) single bedrooms. There was a model furnished bedroom equipped and supplied with appropriate furniture including but not limited to a bed, a chair, a night stan, a lamp and a chest of drawers, bedding, and linens. No client bedroom will be used as a public or general passageway to another room, bath, or toilet. There were no visible hazards or discrepancies observed. BATHROOMS: LPA observed toilets and handwashing stations to be in operation condition. Solid waste containers are in good repair and have tight-fitting covers. Facility provides each resident privacy and personal accommodations. Additionally, bathrooms had slip resistant mats, however, LPA observed missing grab bars next to the toilets in all bathrooms except for bathroom #6. Water temperatures were measured in all residents’ bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. KITCHEN: Appliances and fixtures appeared clean and functional. At the time of the visit, LPA observed a sufficient amount of dining and cookware. Perishable food will be supplied once license is approved. Administrator is aware that food supply shall accommodate a maximum capacity of six (6) residents and facility staff for seven (7) days. Sharps and knives will be stored in locked kitchen drawer. There were no visible immediate hazards observed. Water temperatures measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. Continued on LIC 809-C Continued from LIC 809-C COMMON AREAS: These include the Family Room, Living Room and Dining Room. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. At the time of the visit, LPA observed missing furniture including a dining table. Administrator stated that furniture is schedule to be delivered in the next days. The facility has a fireplace in the family room. At the time of the visit, LPA observed the fireplace not to be properly screened. Administrator will purchase a screen to cover fireplace. There will be a designated cellphone available for resident’s use. Facility will provide internet service for resident use. Facility has enough space to store clean common linen items such as bed sheets, towels, pillowcases, and mattress pads. LPA observed night lights in all hallways and passages. Facility has an auditory signal system in place at the time of the visit. Facility is equipped with two fire doors to enhance safety and prevent the spread of fire. Administrator stated that Fire doors will be closed at all times. At the time of the visit LPA did not observe a magnet to prevent doors from closing. LAUNDRY ROOM: LPA observed a washer and a dryer machine. Furthermore, LPA observed a locked cabinet where medication will be stored. Facility will properly document medication on the Centrally Store Medication and Destruction log. Additionally, Administrator will use extra cabinets to store facility’s fist aid kit, emergency food and water supplies, staff and residents’ files, non-perishable food, and hygiene products. SURROUNDING GROUNDS: Garden and yard are easily accessible to residents, and they are sufficient in size, comfortable and appropriately equipped for outdoor use. There was a shaded area with proper furniture for outdoor use. LPA observed two (2) self-closing and latching side gates. LPA observed a non-working creek on the property. At the time of the visit, LPA did not observe water running through the creek. Also, LPA observed an operational water fountain located at the front entrance of the facility. The water fountain was functioning properly at the time of the inspection, and no issues were noted. Additionally, LPA observed sufficient space to accommodate outdoor activities for residents. At the time of the visit, LPA observed construction workers installing railings and gates alongside the backyard. This project shall be completed before licensure. LPA observed video recording cameras facing the outside of the property. LPA explained that if cameras can record sound, administrator shall submit a waiver due to the audio component, to update plan of operation and admission agreement. Continued on LIC 809-C Continued from LIC 809-C GARAGE: LPA observed a locked garage, which contains emergency disaster supplies and locked chemical storage. Administrator stated that permits to convert part of the garage into a staff room is pending approval from Ventura County officials. LPA explained to Administrator that once permit is approved and construction begins, Community Care Licensing (CCL) shall be informed. COMPONENT III ORIENTATION: A Component III Orientation was conducted with the Administrator during today's visit. The following needs to be completed/Photos sent to LPA prior to licensure:  Door separating bedroom #6 from shared bathroom.  Install grab bars next to all toilets except for bathroom #6.  Picture of installed furniture on common areas.  A screened fireplace.  Picture of backyard showing finished gates and railings.  New sketch showing “garage” instead of “staff room.”  Fire extinguisher’s purchase receipt. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. A copy of the Licensing Report was issued.the state’s words, verbatim · CDSS document, Jan 6, 2025