The Hills of Mallorca

Type of visit: Case Management - Licensee Initiated

On July 8, 2026, Licensing Program Analysts (LPAs) Brandon Lopez and Taylor Simerly made an unannounced visit to the facility to conduct a Case Management closure visit. LPAs were greeted and granted entry into the facility by the landlord of the property, Witness #1 (W1), after explaining the purpose for the visit. Licensee Maricel Nepomuceno later arrived to assist with the inspection. During the visit, LPAs conducted a tour of the premises including the interior and exterior portions of the facility. LPAs inspected the four bedrooms, two bathrooms, and all other common areas including the living room, dining room, and two car garage. LPAs observed the facility to be vacant and to not be in operation. Per the Licensee, the last resident moved out of the facility on June 15, 2026. During today's visit, the Licensee surrendered the facility license. LPAs informed the Licensee that Community Care Licensing will close the facility and that the forfeiture of license letter would be mailed to their address. 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 Licensee Maricel Nepomuceno and a copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, Jul 8, 2026

Type of visit: Case Management - Health Checks

On June 16, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by Administrator (AD) Eleazar Cuyson after explaining the purpose for the visit. On today's visit, there are no residents in care and the facility is vacant. LPA was informed by the AD that the last resident moved out of the facility on June 15, 2026. LPA, accompanied by the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be vacant. LPA inspected all other common areas including the living, dining room, kitchen, and two car garage and observed them to be free of any hazards. LPA observed all of the facilities utilities to be operational during the visit. LPA confirmed during the visit that the facility is currently not operational. During the visit, LPA conducted an interview with the landlord of the property, Witness #1 (W1). W1 stated that the Licensee did not pay the June 2026 rent, which covers the period of June 1, to June 30, 2026. W1 stated that the rent owed is $7,000.00 and that it was due on June 5, 2026. W1 stated that as a result, he served a 3-day notice to pay rent or quit to the Licensee on June 9, 2026. W1 stated that he did not receive the June 2026 rent payment after serving the notice, so he filed an unlawful detainer against the Licensee on June 15, 2026. Based on the observations and information gathered during today's visit, a deficiency will be cited on the attached LIC809-D page. A civil penalty will also be assessed in the amount of $250.00 for a repeat violation, since the Licensee violated the same regulation on May 12, 2026. An exit interview was conducted with Administrator Eleazar Cuyson. A copy of the report and appeal rights were provided to the facility at time of visit.the state’s words, verbatim · CDSS document, Jun 16, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Jun 17, 2026

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observation and records the Licensee does not have an adequate financial plan for the facility since he was served with a 3-day notice to pay rent or quit and an unlawful detainer due to missed rent payment. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 16, 2026

Plan of correction: The Administrator stated that he will communicate with the Licensee to address the unlawful detainer. The Administrator agreed to provide LPA a financial plan on how they will address the unlawful detainer and owed rent. The Administrator agreed to provide LPA the plan via email or fax by POC due date.

Type of visit: Case Management - Health Checks

On May 26, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, there are two residents in care and there were two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied by the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 105.1 and 105.4 degrees Fahrenheit. LPA inspected the facility's kitchen area and observed it to be clean. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No additional health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and two residents during the visit. The three staff interviewed reported no issues with their wages. CONTINUED ON LIC809-C On May 8, 2026, the Department notified the Licensees that they have began proceedings to revoke the license of the facility. Per Health and Safety Code Section 1569.38(b)(1): "(b) A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party, if any, and the local long-term care ombudsman, within 10 days from the occurrence of either of the following events: (1) The department commences proceedings to suspend or revoke the license of the facility pursuant to Section 1569.50." During today's visit, eighteen days after the Licensees were notified of the proceedings, one resident and their responsible party both confirmed that they have not received any written notice from the facility regarding the proceedings to revoke the facility's license. In addition, per Health and Safety Code Section 1569.38(e): "(e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility, that may include where the mail boxes are located, where the facility license is posted, or any other easily accessible location in the facility. The posting shall include all of the following information:" On today's visit, LPA observed that the facility did not a copy of the notice posted in the facility. The three staff interviewed confirmed that they are aware of the proceeding, that notices have not been provided to residents, their families, and has not been posted at the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809D page. An exit interview was conducted with Administrator Janine Cuyson. A copy of the report and appeal rights were provided to the facility at time of visit.the state’s words, verbatim · CDSS document, May 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b)(1) · Plan of correction due date: May 27, 2026

§1569.38 Posting of licensing reports; disclosure to new residents: (b) A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party .. within 10 days.. (1) The department commences proceedings to..revoke the license of the facility.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not ensure that residents and their responsibly parties were notified of proceedings to revoke the facility's license within 10 days. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: The Administrator stated that she will provide the written notices to the two residents, and their responsible parties regarding the proceedings. The Administrator agreed to provide LPA proof of the written notice via email or fax by POC due date. LPA will also follow up with the residents and their responsible parties to confirm that written notices were received.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1568.38(e) · Plan of correction due date: May 27, 2026

§1569.38 Posting of licensing reports; disclosure to new residents: (e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice.. in the facility.. This requirement is not evidenced by: Based on observation, the Licensee did not ensure that a notice regarding the proceedings was posted at the facility as LPA did not observe it during today's visit. Staff also corroborated that the notice has not been posted. This poses an immediate health and safety risk to persons in carethe state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: The Administrator stated that she will post the notice of the proceeding in the facility. The Administrator agreed to provide LPA proof of posting via email or fax by POC due date. LPA will also conduct a follow up visit to confirm the notice has been posted.

Type of visit: Case Management - Health Checks

On May 12, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Eleazar Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, there are two residents in care and there were two staff present. LPA observed residents to be in clean clothes. LPA, accompanied a staff, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 103.1 and 105.2 degrees Fahrenheit. LPA inspected the facility's kitchen area and observed it to be clean. LPA observed the kitchen areas to be free of any vermin during the visit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No additional health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with four staff and two residents during the visit. Four out of the four staff stated that they received their pay for the most recent pay period which ended on May 7, 2026. CONTINUED ON LIC809-C As of today, LPA has also not received the full extent of the financial documents that were requested during a visit to the facility conducted on April 14, 2026. Based on the observations made during today's visit, a deficiency will be recited on the attached LIC809-D page and a technical violation will be issued. Additionally, the Licensee will be issued a civil penalty for a repeat violation in the amount of $250.00, since the Licensee was previously issued a citation for California Code of Regulation Title 22 Section 82713 on March 9, 2026. An exit interview was conducted with Administrator Eleazar Cuyson. A copy of the report and appeal rights were provided at time of visit.the state’s words, verbatim · CDSS document, May 12, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: May 13, 2026

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not provide all the requested financial documents to Community Care Licensing as requested to assess their current financial situation. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 12, 2026

Plan of correction: The Licensee stated that he will provide LPA the requested fiancial documents.The Licensee agreed to provide LPA the written plan via email or fax by POC date

Type of visit: Case Management - Health Checks

On May 1, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, the facility currently has a census of three residents, however, there were only two residents present at time of visit. LPA observed residents to be in clean clothes. LPA, accompanied a staff, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 105.5 and 105.9 degrees Fahrenheit. LPA inspected the facility's kitchen area. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed dead cockroaches to be present in various areas throughout the kitchen, including in the kitchen pantry, under the sink, and under the stove. LPA observed a total of fourteen cockroaches during the visit. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No additional health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and two residents during the visit. Three out of three staff stated that they received their pay for the most recent pay period which ended on April 30, 2026. CONTINUED ON LIC809-C The three staff reported that the next pay date would be on May 7, 2026, and it would cover the hours they worked from April 27, to May 3, 2026. During the previous visit conducted to the facility on April 14, 2026, LPA requested the following documents to be submitted to him by close of business day April 17, 2026, to assess the Licensees current financial situation: Proof of rent payments for March and April 2026. All utility bills (water, gas, electricity, trash, internet) for March 2026. Payroll records for March 2026. As of today, May 1, 2026, LPA has not received any of the records requested. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D page. An exit interview was conducted with Administrator Janine Cuyson. A copy of the report and appeal rights were provided at time of visit.the state’s words, verbatim · CDSS document, May 1, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(27) · Plan of correction due date: May 2, 2026

87555 General Food Service Requirements: (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not evidenced by: Based on observation, the Licensee did not ensure kitchen areas to be free of vermin as LPA observed fourteen dead cockroaches to be present in various areas throughout the kitchen. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 1, 2026

Plan of correction: The Administrator stated that she will communicate with the Licensee to have a pest control company to address the cockroaches. The Administrator agreed to provide LPA an invoice for the pest control service via email or fax by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: May 2, 2026

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not provide all the requested financial documents to the Department as agreed upon to assess their current financial situation. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 1, 2026

Plan of correction: The Licensee stated that they will provide the requested financial documents to LPA. The Licensee agreed to provide LPA the documents via email or fax by POC date.

Type of visit: Case Management - Health Checks

On April 14, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone but was unable to assist with today's inspection. On today's visit, LPA observed three residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied a staff, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 109.4 and 109.9 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of three staff stated that they were up to date on their pay. The three staff reported that the next pay period would be on April 16, 2026, and that it will cover the hours they worked from April 6, to April 12, 2026. CONTINUED ON LIC809-C In order to assess the Licensees current financial status, LPA is requesting the following documents to be submitted to him via email by close of business day April 17, 2026: Proof of rent payments for March and April 2026. All utility bills (water, gas, electricity, trash, internet) for March 2026. Payroll records for March 2026. Based on the observations made during today's visit, no deficiencies are being cited per 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, Apr 14, 2026

Type of visit: Case Management - Health Checks

On April 7, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with today's inspection. On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 109.2 and 111.2 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of three staff stated that they were up to date on their pay. The three staff reported that the next pay period would be on April 9, 2026, and that it will cover the hours they worked from March 30, to April 5, 2026. CONTINUED ON LIC809-C Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Janine Cuyson and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 7, 2026

Type of visit: Case Management - Health Checks

On April 1, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with today's inspection. On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 109 and 112.1 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of three staff stated that they were up to date on their pay. The three staff reported that the next pay period would be on April 2, 2026, and that it will cover the hours they worked from March 23, to March 29, 2026. CONTINUED ON LIC809-C Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Janine Cuyson and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 1, 2026

Type of visit: Case Management - Health Checks

On March 24, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Eleazar Cuyson was notified via telephone and later arrived to assist with today's inspection. On today's visit, LPA observed five residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 108.6 and 109.5 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with two staff and five residents during the visit. Two out of two staff stated that they were up to date on their pay. The two staff reported that the next pay period would be on March 26, 2026, and it will cover the hours they worked from March 16, to March 22, 2026. CONTINUED ON LIC809-C Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Eleazar Cuyson and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Case Management - Health Checks

On March 20, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with today's inspection. On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 105.9 and 111.7 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of three staff stated that they were up to date on their pay. The three staff reported that the next pay period would be on March 22, 2026, and it will cover the hours they worked from February 19, to March 15, 2026. CONTINUED ON LIC809-C Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Janine Cuyson and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 20, 2026

Type of visit: Case Management - Health Checks

On March 9, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with today's inspection. On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied by a care giving staff, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 109.4 to 110.6 degrees Fahrenheit. LPA observed one set of lights in one of the resident bathrooms continues to be non-operational and has not been fixed yet. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. CONTINUED ON LIC809-C Three out of the three staff interviewed reported that they were initially supposed to be paid on March 5, 2026, for the hours they worked from February 4, to February 18, 2026. However, their pay date was changed to March 7, 2026. Three out of three staff interviewed reported that they have not been paid for the hours they worked from February 4, to February 18, 2026, and have not been told when they will be getting paid. Based on the observations made during today's visit, a deficiency is being cited on the attached LIC809-D page. A civil penalty will also be assessed in the amount of $250.00 for a repeat violation. The Licensee is receiving the same citation that was previously issued on February 24, 2026. An exit interview was conducted with Administrator Janine Cuyson. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 10, 2026

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not provide all the requested documents to Community Care Licensing as agreed upon. Additionally, the Licensee did not ensure staff have been paid on schedule. This poses an immedate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 9, 2026

Plan of correction: The Licensee stated that they will provide a written plan to LPA on when they will submit the requested documents on how they will address the owed wages of staff. The Licensee agreed to provide LPA the written plan via email or fax by POC date.

Type of visit: Case Management - Health Checks

On March 4, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied by the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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. The water in each of the resident bathroom was operational and measured between 108.6 to 111.7 degrees Fahrenheit. LPA observed one set of lights in one of the resident bathrooms continues to be non-operational. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of the three staff interviewed reported that they received their owed wages from the pay period of February 13, 2026, and were currently up to date on their pay. The three staff interviewed reported that their next pay date is on March 5, 2026. CONTINUED ON LIC809-C Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. However, civil penalties will be assessed on today's visit for failures to correct. The Licensee still has not corrected deficiencies that were cited during previous visits conducted on February 20, and February 24, 2026. The Licensee will receive a civil penalty in the amount of $800.00 for each visit, for a total of $1,600.00. An exit interview was conducted with Administrator Janine Cuyson. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 4, 2026

Type of visit: Case Management - Health Checks

On February 24, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied by the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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 observed that two lights in one of the resident bedrooms, was not operational. LPA inspected the two shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. The water in each of the resident bathroom was operational and measured between 108.5 to 111.7 degrees Fahrenheit. LPA observed three light bulbs in one of the resident bathrooms was not operational. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of the three staff interviewed reported that they were supposed to be paid on February 13, 2026, for the hours they worked from January 21, to February 3, 2026. CONTINUED ON LIC809-C However, the three staff stated that they have not been paid as of today, therefore, the Licensees are eleven days behind on the scheduled pay date. Three out of three staff interviews also stated that they have been paid late in previous pay periods. LPA observed the facility is up to date on their annual fees. Additionally, during the Non-Compliance Conference held on February 10, 2026, the Licensees agreed to the following terms: Licensees plan to downsize and consolidate facilities. The Licensees stated that they will provide a plan to the Department on which facilities they will consolidate by close of business February 12, 2026. Licensees plan to pay a minimum balance of the outstanding utility bills for all 16 of their licensed facilities. The Licensee stated that they will provide proof of payments for the utility bills to the Department by close of business February 13, 2026. Licensees plan to pay off all their debt, including overdue balances for rent/mortgage payments and utility bills. The Licensees stated that they will also obtained liability insurance for all 16 of their licensed facilities. The Licensees stated that they will provide a plan to the Department by close of business February 17, 2026, on when they plan to pay off all of their debt and obtain liability insurance for their facilities. As of the agreed upon due date of February 13, 2026, the Licensee did not provide any proof of payments for the utility bills for the facility. As the agreed upon due date of February 17, 2026, the Licensee did not submit a plan to the Department on how they will pay off all of their debt for this facility. Based on the observations made during today's visit, a deficiencies are being cited on the attached LIC809-D page. Civil penalties will also be assessed in the amount of $250.00 and $400.00 for repeat violations. An exit interview was conducted with Administrator Janine Cuyson. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Feb 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 25, 2026

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not provide all the requested documents to Community Care Licensing as agreed upon. Additionally, the Licensee did not ensure staff have been paid on schedule. This poses an immedate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: The Licensee stated that they will provide a written plan to LPA on when they will submit the requested documents on how they will address the owed wages of staff. The Licensee agreed to provide LPA the written plan via email or fax by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Mar 10, 2026

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 was not evidenced by: Based on observation, the Licensee did not ensure the facility is in good repair. LPA observed two lights in a resident's bathroom to be non-operational and three light bulbs in a resident bathroom to be non-operational. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: The Adminsitrator stated that she will contact their maintenance department to ensure repairs are made. LPA will conduct a subsequent visit to ensure repairs have been made.

Type of visit: Case Management - Health Checks

On February 20, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied by a caregiver staff, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents 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 observed the lights in each of the resident's bedroom to be operational. LPA inspected the two shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. The water in each of the resident bathroom was operational and measured between 109 to 112.1 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of the three staff interviewed reported that they were supposed to be paid on February 13, 2026, for the hours they worked from January 21, to February 3, 2026. However, the three staff stated that they have not been paid as of today, but that they were informed they would be paid sometime this week.CONTINUED ON LIC809-C Two out of three staff interviews also stated that they have been paid late in previous pay periods. LPA observed the facility is up to date on their annual fees. The Licensees were also unable to provide proof of current RCFE liability insurance during the visit. Additionally, the Department requested the Licensee to provide the following documents for this facility by 3 PM, February 6, 2026, to assess their current financial situation: Financial records (balance sheets, income statements, general ledgers) from October 2025 to January 2026. Rent payments from October 2025 to January 2026. Utility bills (electricity, water, gas, internet) from October 2025 to January 2026. Payroll records from October 2025 to January 2026. As of the agreed upon due date, the Licensee did not provide any payroll records for the facility. The Licensee did not provide any balance sheets or income statements for the facility. The Licensee did not provide the general ledger for January 2026 for the facility. The Licensee did not provide the rent payments from October 2025 to December 2025. The Licensee also did not submit the full extent of the utility bills requested. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D page. Civil penalties will also be assessed in the amount of $250.00 for a repeat violation. An exit interview was conducted with Administrator Janine Cuyson. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Feb 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 21, 2026

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not provide all the requested documents to Community Care Licensing as agreed upon. Additionally, the Licensee did not ensure staff have been paid on schedule. This poses an immedate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: The Licensee stated that they will provide a written plan to LPA on when they will submit the requested documents on how they will address the owed wages of staff. The Licensee agreed to provide LPA the written plan via email or fax by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Feb 21, 2026

§1569.605 Liability insurance; coverage requirements: ..all residential care facilities for the elderly.. shall maintain liability insurance covering injury to residents and guests.. This requirement was not evidenced by: Based on observation, interviews, and records reviewed, the Licensee did not ensure there was RCFE liability insurance for the facility. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: The Administrator stated that she will create a written plan on how the Licensee will obtain RCFE liability insurance for the facility. The Administrator agreed to provide LPA the written plan via email or fax by POC date.

Type of visit: Case Management - Health Checks

On February 4, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Janine Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, LPA observed four residents in care and two care giving staff present. LPA observed residents to be in clean clothes. LPA, accompanied by a caregiver staff, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed that Resident #4 (R4) had full bed rails on her bed, however, R4 is currently not receiving hospice services. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. The water in each of the resident bathrooms was operational and measured between 109.4 to 111.9 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. Three out of the three staff interviewed confirmed that they are up to date on their salary and have been paid on time. CONTINUED ON LIC809-C LPA reviewed the files for the four residents in care. LPA observed that there was no Pre-Admission Appraisal on file for Resident #1 (R1). LPA observed that there was no Reappraisal on file for R1. LPA observed that the Reappraisals on file for Resident #2 (R2) and Resident #3 (R3) were outdated. LPA also observed that there were no functional capability assessments on file for the four residents in care. All staff present during the visit were background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. An exit interview was conducted with Administrator Janine Cuyson. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Feb 4, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Feb 20, 2026

87457 Pre-Admission Appraisal: (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs... This requirement was not evidenced by: Based on observations and records reviewed, the Licensee did not ensure there was a Pre-Admission Appraisal on file for Resident #1 (R1). This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 4, 2026

Plan of correction: The Administrator stated that she will complete a Pre-Admission Appraisal for R1. The Adminstrator agreed to provide LPA the Pre-Admission Appraisal for R1 via email or fax by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Feb 20, 2026

87463 Reappraisals: (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first... This requirement was not evidenced by: Based on records reviewed, the Licensee did not ensure there was a Reappraisal on file for Resident #1 (R1) and that the Reappraisals for Resident #2 (R2) and Resident #3 (R3) were updated as frequently as necessary. This poses a potential health, safety, & personal rights risk.the state’s words, verbatim · CDSS document, Feb 4, 2026

Plan of correction: The Administrator stated that she will complete Reappraisals for R1, R2. and R3. The Administrator agreed to provide LPA the Reappraisals for R1, R2, and R3, via email or fax by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87459(a) · Plan of correction due date: Feb 20, 2026

87459 Functional Capabilities: (a) The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited to.. This requirement was not evidenced by: Based on observations and records reviewed, the Licensee did not ensure that there were functional capability assessments on file for the four residents in care. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 4, 2026

Plan of correction: The Administrator stated that she will complete functional capability assessments for all four residents. The Administrator agreed to provide the functional capability assessments for all four residents via email or fax by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608(a)(5)(B) · Plan of correction due date: Feb 20, 2026

87608 Postural Supports (a) ... Postural supports may be used ..(5) Under no circumstances shall postural supports include..(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care. This requirement was not evidenced by: LPA observed that Resident #4 (R4) had full bed rails, however, R4 is currently not receiving hospice services and did not have an order on file for any bed rails. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 4, 2026

Plan of correction: The Administrator stated that the facility will not use the full bed rails for R4. The Administrator stated that they will get an order for half bed rails for R4. The Administrator agreed to provide the half bed rail order for R4 to LPA via email or fax by POC date.

Type of visit: Case Management - Health Checks

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a case management/health check visit. LPA was greeted and granted entry by the facility caregiving staff after stating the purpose of the visit. Administrator Janine Cuyson was present on the premises and assisted with the visit. During the visit, LPA was able to verify that utilities were currently active. Room temperature was measured at 72.8F. Electricity and cable service are on. Water temperature was measured at 110F. Per facility staff interviewed, the weekly grocery run was conducted earlier on the day. Adequate supply of perishable and non-perishable food items observed in the refrigerator, freezer and pantry. There are adequate cleaning and laundry supplies stored in the garage, along with incontinence supplies in large quantity. LPA conducted two staff interviews during the visit. Two out of two interviews indicated that the next pay day is January 9, 2026 and confirmed that wages for the previous pay period had been paid with a few days' delay. Type B deficiency issued. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.the state’s words, verbatim · CDSS document, Jan 8, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: Jan 31, 2026

Per CCR 87213 on Finances: "The licensee shall have a financial plan(...) that assures sufficient resources to meet operating costs for care of residents". This requirement is not met as evidenced by: Based on the review of utilities requested during the present visit, multiple occurrences of late payments were recorded for staff wages. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: Licensee will provide proof of timely payment for January wages before the plan of corrections due date.

Type of visit: Case Management - Legal/Non-compliance

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting a case management visit following up on the non-compliance conference that took place on July 30, 2025. LPA was greeted and granted entry after introducing himself and stating the purpose of the visit. Administrator Janine Cuyson was notified via telephone and arrived later to assist with the visit. During the present visit, LPA accompanied by staff conducted a tour of the physical plant and observed the following: There are currently 4 residents in care along with two staff members present. Lunch was served between 11:00am and 11:30am for all four residents present. Utilities are confirmed to be running, electricity and air conditioning are in operation. Bathroom faucets are verified to dispense hot water at 114F. Food supplies are verified to be present in sufficient quantities. Emergency food and water supplies are present. Cleaning and laundry supplies are present as well. LPA conducted two staff and two resident interviews. Additionally, LPA requested the following documentation from facility staff: - Payroll records for August, September, and October, 2025, (to be provided shortly via email) - Grocery receipts for August, September, and October, 2025 (provided during the visit) - Utility bills (water, gas and electricity) or August, September, and October, 2025 (provided during the visit), - Proof of rent payments for August, September, and October, 2025 (to be provided via email). Based on the observation and records reviewed during the present visit, no deficiencies are being cited during the present visit. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Eleazar Cuyson was notified via telephone and arrived later to assist with the visit. There are currently six residents in care, three of which are receiving hospice care at this time. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas. LPA accompanied by facility staff toured the physical plant. The facility is a two-story house with an attached garage, with two private bedrooms, two shared bedrooms. There are are one shared and one en-suite bathrooms on the premises. The upstairs portion of the house is strictly for staff use and verified not to house any residents during the visit. Bedrooms appear clean and sanitary. Two resident receiving hospice care are observed to have a bed equipped with full-length bed rails. Hospice plans of care reviewed. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 126.2F and 132.2F at two separate faucets used for personal grooming. Type A deficiency cited and civil penalty assessed for repeat violation.. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. The fire extinguishers present are charged with up-to-date maintenance tag. Carbon monoxide and smoke detectors were found to be present and operational. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 The garage is secured and used for the storage of supplies and food as well as the laundry area. Emergency food and water supplies verified to be present. All utilities (gas, water, electricity, internet and cable) are verified to be operational during the visit. Fresh groceries are also present. LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with furniture for resident use. The identified routes of egress are free of clutter and obstructions. There are self-latching gates on both sides of the premises. There are no bodies of water on the premises. Egress alarms are in use on exit doors, however facility does not utilize locked perimeters or delayed egress. LPA reviewed six resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for all six residents with no discrepancies observed. Two residents are found to have been assessed as bedridden per their latest physician reports, however the current fire clearance does not include a provision for bedridden residents. Type A deficiency cited and immediate civil penalty assessed due to the failure to meet the requirements of the fire clearance. LPA reviewed staff records for three staff members present during the visit. CPR training, initial and annual training reviewed for 2024 and 2025. Disaster drills are conducted and documented. Staff members are verified to be background cleared and associated to the licensed location. Based on the observations conducted during the present visit, two type A deficiencies are being cited per Title 22 of the California Code of Regulations. A civil penalty for repeat violation along with an immediate civil penalty were assessed during the visit. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Jul 17, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

On June 20, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced Case Management visit for a Health and Safety check. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone and later arrived to assist with the inspection. On today's visit, LPA observed six residents in care and two care giving staff present. LPA observed residents eating lunch in the dining room which included ribs, baked beans, and rice. LPA observed residents to be in clean clothes. LPA, accompanied by the AD, conducted a tour of the physical plant. LPA inspected the four resident bedrooms and observed them to be free of hazards. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed the lights in each of the resident bedrooms to be operational. LPA inspected the two shared resident bathrooms and observed them to be clean. The water in each of the resident bathrooms were operational. Hot water temperature measured between 141.8 to 157.2 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. LPA observed the facility has additional hygiene supplies stored in the garage. No health or safety concerns were observed. LPA additionally conducted interviews with staff and residents. Based on the observations made during today's visit, a deficiency is being cited on the attached LIC809-D. An exit interview was conducted with Administrator Eleazar Cuyso . A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jun 20, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Jun 23, 2025

87303 Maintenance and Operation: (e): Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care...Hot water temperature controls shall be maintained...of not less than 105 degrees F and not more than 120 degrees F. This requirement is not evidenced by: The licensee failed to ensure the hot water was within regulatory requirement as the hot water temperature measured between 141.8 to 157.2 degrees Fahrenheit. This poses an immediately health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 20, 2025

Plan of correction: AD agreed to contact the corporate office to notify them of the issue and request it to be fixed. AD agreed to provide proof of the request. AD also agreed to create a log of hot water once the repair has been complete. AD agreed to provide proof of the request to LPA via email or fax by POC date.

Type of visit: Office

On today's date, Licensing Program Managers (LPM) Alisa Ortiz and Licensing Program Analysts (LPAs) Michael Tea and Brandon Lopez met with Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy on this day for the purpose of discussing financial operations and distress and reporting requirements The following was discussed: Licensee's responsibilities of facility oversight Licensee's requirement to maintain control of facility and property Licensee’s responsibility to maintain financial solvency Licensee’s responsibility to communicate with the department Report of suspected dissolution of partnership Report continued on LIC809-C The following was agreed upon during today's meeting: The Licensee has clarified the dissolution of partnership is not related to license, but rather a separate business deal. The dissolution of partnership will not impact licensee’s facilities. The Licensee has reported they are in communication with landlords for properties leased and will maintain a valid lease and control of property. The Licensee will maintain payment of all facilities bills and ensure sufficient staffing to meet residents needs, the Licensee will communicate any health and safety concerns related to residents in care to the department immediately. The following items are to be provided to the Department: Updated LIC 500 Personnel Report identifying all current working staff and their agreed upon schedules by close of business May 29, 2025. Updated lease agreements with letters from landlords voiding any outstanding evictions or unlawful detainers by close of business May 23, 2025. A copy of loan contract to support financial solvency by close of business May 29, 2025. An exit interview was conducted Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy. A copy of this report, LIC 809, was provided to Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy.the state’s words, verbatim · CDSS document, May 22, 2025

Allegation investigated: Facility is in financial distress. Facility did not meet the reporting requirements.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the two allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Eleazar Cuyson was notified via telephone and assisted with the visit remotely. Report read to administrator who gave caregiving staff permission to sign on their behalf. An initial investigation visit was conducted on April 14, 2025. During the visit, LPA accompanied by staff conducted a tour of the physical plant and reviewed the facility's food supply, incontinence supplies and hot water supply. Resident records for all individuals admitted at this time were also reviewed. A total of four staff interviews and one resident interview were conducted. CONTINUED ON FORM LIC9099-C Substantiated CONTINUED FROM FORM LIC9099 Regarding the allegation that Facility is in financial distress, the following has been concluded: Based on staff interviews conducted and correspondence obtained during the investigation, the licensee has been unable to provide timely payments of the rent as required by the leasing agreement signed with the owner of the property in which the facility operates. As of the initial visit, past rent due extended to January 2025. On May 2, 2025, an unlawful detainer was served by the landlord to the licensee, confirming that the situation was still ongoing. Evidence therefore corroborates financial issues experienced by the licensee. Regarding the allegation that Facility did not meet the reporting requirements, the following has been concluded: Neither the initial financial issues nor the issuance of a unlawful detainer were reported to the Department by facility staff. Reporting requirements were therefore not met. As a result, both allegations are found to be Substantiated, meaning that the preponderance of evidence threshold has been met. Corresponding deficiencies are cited on an attached form LIC9099-D. An exit interview was conducted with the administrator and a copy of this report along with appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, May 20, 2025 · control 22-AS-20250410141252

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: Jun 16, 2025

Per CCR Section 87213 on Finances: "The licensee shall have a financial plan (...) that assures sufficient resources to meet operating costs for care of residents". This requirement is not met as evidenced by: Based on records reviewed and interviews conducted,(...) it has been determined that the licensee had been unable to cover operating costs related to the leased property for the period of January to April 2025. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, May 20, 2025

Plan of correction: Licensee stated a resolution was in progress involving a modification of the ownership structure. Proof of initial application to be provided to the LPA

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(d) · Plan of correction due date: Jun 16, 2025

Per CCR 87211(d): "The licensee shall notify the Department in writing within two business days of any of the following specified events, or knowledge thereof: (...) (2) An unlawful detainer action is initiated against the licensee. (...)(4) The licensee receives a written notice of default of payment of rent. This requirement was not met as evidenced by: Based on interviews conducted and records reviewed, no written reports of past due rent or of an unlawful detainer were provided to the Department. This constitutes a potential risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, May 20, 2025

Plan of correction: Licensee will provide a statement indicating that they have reviewed the reporting requirements and intend to adhere to them. Statement to be provided in writing to the Department before the plan of corrections due date.

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of documenting deficiencies observed during the investigation of complaint reference 22-AS-20250410141252. During the visit, LPA conducted a review of resident records maintained at the facility and observed that residents admitted prior to the change of ownership and issuing of the current license still had admission agreements signed with previous ownership while two residents admitted after the license was issued had no signed admission agreement on file at all. Type B deficiency cited. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Apr 14, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(c) · Plan of correction due date: Apr 21, 2025

Per CCR Section 87507(c): "(c) Admission agreements shall be signed and dated (...) by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative no later than seven days following admission." This requirement is not met as evidenced by: Based on records reviewed during the facility visit, there are no current signed admission on file for any of the five residents with the presently licensed entity. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Apr 14, 2025

Plan of correction: Licensee to obtain current and signed admission agreements for all five residents and submit copies to LPA before the plan of corrections due date.

Type of visit: Prelicensing

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility to follow-up on the initial pre-licensing visit held on July 19, 2024. LPA was greeted and granted entry by Maricel Nepomuceno, licensee and Eleazar Cuyson, administrator. LPA was able to verify that the physician report for resident R1 had been adequately signed by the resident's primary care physician. Water temperature was also measured to be 120F. Based on these updated observations, LPA was able to confirm that the applicant is ready for licensing. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Jul 26, 2024

Type of visit: Prelicensing

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility for the purpose of conducting a pre-licensing inspection. LPA was greeted and granted entry by Maricel Nepomuceno, licensee. An initial application for a license to operate as a Residential Care Facility for the Elderly was received by the Department on January 16, 2023 for a capacity of six non-ambulatory residents. This is a change of ownership with five residents already in care. All five of the currently admitted individuals are receiving hospice care. The applicant has requested a hospice waiver for six residents. LPA accompanied by administrator toured the physical plant. The facility is a two-level home with a frontyard, backyard and attached garage, with the entire second floor dedicated to staff dwellings and administrative offices. There are two shared bedrooms and two private bedrooms with one shared bathroom. Each of the bedrooms include all necessary components of furnishing including a light, chair, storage space for personal items and a full-size bed as well as a supply of linen and bedsheets. Water temperature was measured at 122F, which is higher than the maximum required of 120F. Common living spaces are present and a device connected to the internet is present for the use of the residents in care. Facility is clean, sanitary and free of odors in all areas inspected. Required posted documents are observed to be present. Kitchen equipment is present and operating as required. Sharp items and cleaning supplies are confirmed to be secured. A sufficient supply of perishable and non-perishable food is present as required by Title 22 Regulations. The centrally stored medication storage is located in a secure cabinet with a digital combination lock. The garage is used for additional storage of food along with emergency and back-up supplies along with a laundry area. The entrance to the garage is also secured with a digital lock. Sound alarms are present on the other ways of egress. CONTINUED ON FORM LIC809-D CONTINUED FROM FORM LIC809 Staff and five client records were reviewed and confirmed to include all necessary components, with the exception of one outdated medical assessment for one of the residents with a dementia diagnosis. The resident in question has been assessed by the hospice physician upon admission into hospice, however the assessment form is missing a date and signature when reviewed during the visit. The fire clearance has been obtained and provided to the Department before the pre-licensing visit. Combined smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional. Fire extinguishers present on the premises are observed to be charged with current maintenance tags. First aid kit verified to be complete. LPA and licensee toured the outside of the facility and observed it to be free of obstructions. One shaded area is present in the backyard and is equipped with outdoor furniture for the enjoyment of residents and visitors. The perimeter gates present on both sides of the house are self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Component III was waived as the prospective licensee has already been acting as the current facility administrator and operates other licensed locations as well. This report was reviewed with facility representative and a copy of this report was emailed to the prospective licensee before the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 19, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census : 5 Method: Telephone call with CAB COMP II Participants: Maricel Nepomuceno (Licensee), Eleazar Cuyson (Administrator), & Tammy Edwards, (Analyst). Licensee & administrator participated in COMP II via Telephone call with CAB Analyst. Identification of licensee/ administrator was verified by confirming driver’s license numbers. During COMP II, licensee/ administrator confirmed the understanding of Title 22. Component II was successfully completed. Licensee/administrator were advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed licensee's/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, Jun 18, 2024