The Hills of Orchid

Type of visit: Case Management - Other

On July 9, 2026, at 9:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted a case management visit to verify facility closure. LPA Kim met with Licensee Allen Medina to verify facility ceased operation and to obtain the surrendered license. Licensee surrendered the facility license. LPA Kim conducted a walk through with Licensee Medina and verified there are no residents and signs of operation. Licensee submitted the letter of intent to close the facility on July 9, 2026, and the residents’ last day was on June 30, 2026. The location will no longer function as an Residential Care Facility for the Elderly. Based on the observation and interview, the facility is now closed. The Department will proceed with the closure as of July 1, 2026. LPA Kim informed the above facility representative of the licensing procedure for future facility operation if desired. An exit interview was conducted and a copy of this report was provided to Licensee Allen Medina.the state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Case Management - Deficiencies

On June 29, 2026, at 9:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced Case Management Visit to follow-up on deficiencies cited in forms LIC809D on June 15, 2026. LPA Kim was greeted and granted entry by Caregiver (CG) Dania Gonzalez Callero. LPA Kim called Licensee (LICEN) Allen Medina over the phone and LPA explained the purpose of the visit. LICEN Medina informed LPA Kim that Staff Rosendo Carlo Ward could sign on behalf of the facility for the report. LPA Kim toured the physical plant and made the following observations. Deficiency cited under Title 22 Regulation California Health and Safety Code (HSC) 1569.38(e) pertaining to posting a notice in a conspicuous location about the Department commencing proceedings to revoke the facility license has been cleared. The facility posted the notice by the entryway, which was observed during the visit. Deficiency cited under Title 22 Regulation California Health and Safety Code (HSC) 1569.38(b)(1) pertaining to a licensed facility shall provide written notice to a resident, the resident’s responsible party within 10 days from the occurrence of the Department commencing proceedings to suspend license of the facility. LPA observed facility provide a notice the resident and mail out a notice to other residents. Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations. An exit interview was conducted and a copy of this report and POC Clearance letter were provided to Staff Rosendo Carlo Wardthe state’s words, verbatim · CDSS document, Jun 29, 2026

Type of visit: Case Management - Health Checks

On June 15, 2026, at 12:45 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. Upon arrival at the facility, LPA Kim was greeted by Caregiver (CG) Angelo Sanguyo. LPA Kim spoke with Administrator (ADMIN) Eleazar Cuyson over the telephone and explained the purpose of the visit. ADMIN Cuyson stated that he could not attend today's visit and CG Cuyson could sign on behalf of the facility. LPA Kim conducted a health and safety check with CG Sanguyo. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to three residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature in the bathrooms measured between 109.5 degrees F and 118.7 degrees F. The indoor temperature measured at 74 degrees F. All smoke detectors and carbon monoxide detectors were operational. The fire extinguisher mounted in the kitchen and in the hallway were last serviced on March 23, 2026. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. All staff on LIC 500 are cleared and associated to the facility. LPA conducted interviews with one resident and three staff. Resident and staff interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA Kim reviewed and received copies of the facility staff roster and resident roster. Certificate of Liability insurance is effective on April 8, 2026, to April 8, 2027. LPA requested utility invoices and proof of payments through email correspondence dated on June 9, 2026. As of June 15, 2026, at 4:30 PM, LPA Kim did not received the requested utility documentation. CONTINUED ON LIC809-C While on tour of the facility, LPA Kim noticed the facility did not post a notice about the Department commencing proceedings to revoke the facility's license. The regulation states the notice needs to be in 14-point type and be posted in a conspicuous location at the facility. LPA spoke with residents and resident responsible parties about how the Department is commencing proceedings to revoke the facility's license. One witness stated they were not notified with a written notice about the Department commencing proceedings to revoke the facility's license. Prior to transferring the residents to another facility, two witnesses stated the facility did not notify them with a relocation evaluation that had recommendations on the type of facility that would meet the needs of each resident based on the current service plan and a list of facilities, within a 60 mile radius of the resident’s current facility. Deficiencies were cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. Facility did not post up a notice about the Department commencing proceedings to revoke the facility's license. The notice needs to follow the regulation of being in 14-point type and posted in a conspicuous location at the facility. The facility did not send a notice to a resident and resident's responsible party about the Department commencing proceedings to revoke the facility's license. The facility did not provide a resident a relocation evaluation of that resident's needs that would include recommendations on types of facilities that would meet the needs of the resident based on current service plan, and a list of facilities within 60-mile radius of resident's current facility that would meet the resident's present needs prior to transferring to another facility. Facility did not provide utility documentation as requested by email on June 6, 2026. . An exit interview was conducted, and a copy of this report, LIC809D, and appeal rights were provided to Caregiver Angelo Sanguyo.the state’s words, verbatim · CDSS document, Jun 15, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b)(1) · Plan of correction due date: Jun 16, 2026

1569.38 (b)(1) A licensed facility... shall provide written notice to a resident, the resident’s responsible party... within 10 days from the occurrence of...The department commences proceedings to suspend...license of the facility. This require is not met as evidenced by: Based on interviews and record review, the facility did not provide a written notice to a resident and resident's responsible party about Department proceeding to revoke the facility's license. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: Licensee states they will inform with a written notice to all residents and resident's responsible party the Department is commencing proceedings to revoke the facility's license. Licensee will send a copy of the written notice and proof they provided written notices to the resident and resident's responsible party to CCLD via email to edward.kim@dss.ca,gov by POC due June 16, 2026.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.38(e) · Plan of correction due date: Jun 16, 2026

1569.38(e) Upon providing the notice... the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above. The facility did not post a notice about the Department commencing proceedings to revoke the facility's license. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: Licensee state they will post the notice and meet all the requirements for HSC 1569.38(e). They will send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date June 16, 2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Jun 16, 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 (Utilities bills and invoices) to Community Care Licensing as agreed upon. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: The Licensee stated that they will provide the requested documents to CCLD via email to edward.kim@dss.ca.gov by POC due date June 16, 2026.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.682(a)(1) · Plan of correction due date: Jun 26, 2026

HSC1569.682(a)(1) A licensee...shall, prior to transferring a resident of the facility to another facility...as a result of the forfeiture of a license take all reasonable steps to transfer affected residents safely.. Prepare, for each resident, a relocation evaluation of the needs of that resident... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above. The facility did prepare a relocation evaluation for the resident prior to transferring each resident. This poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: Licensee states they will prepare relocation evaluation for all residents that include all requirements based on their care plan and a list of eligible facilitiies within a 60 mile radius. They will send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date June 26, 2026.

Type of visit: Case Management - Health Checks

On May 20, 2026, at 1:30 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. Upon arrival at the facility, LPA Kim was greeted by Caregiver (CG) Angelo Sanguyo. LPA Kim spoke with Administrator (ADMIN) Eleazar Cuyson over the telephone and explained the purpose of the visit. ADMIN Cuyson stated that he could not attend today's visit and CG Cuyson could sign on behalf of the facility. LPA Kim conducted a health and safety check with CG Sanguyo. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to five residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature in the bathrooms measured between 109.5 degrees F and 118.7 degrees F. The indoor temperature measured at 74 degrees F. All smoke detectors and carbon monoxide detectors were operational. The fire extinguisher mounted in the kitchen and in the hallway were last serviced on March 23, 2026. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. All staff on LIC 500 are cleared and associated to the facility. LPA conducted interviews with two residents and two staff. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA Kim reviewed and received copies of the facility staff roster and resident roster. Certificate of Liability insurance is effective on April 8, 2026, to April 8, 2027. CONTINUED ON LIC-809C While on tour of the facility, LPA Kim noticed the facility did not post a notice about the Department commencing proceedings to suspend or revoke the facility's license. The regulation states the notice needs to be in 14-point type and be posted in a conspicuous location at the facility. A deficiency was cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. Facility did not post up a notice about the Department commencing proceedings to suspend or revoke the facility's license. The notice needs to follow the regulation of being in 14-point type and posted in a conspicuous location at the facility An exit interview was conducted, and a copy of this report, LIC809D, and appeal rights were provided to Caregiver Angelo Sanguyo.the state’s words, verbatim · CDSS document, May 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(e) · Plan of correction due date: May 21, 2026

1569.38(e) Upon providing the notice... the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above. The facility did post a notice about the Department commencing proceedings to revoke the facility's licensea. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 20, 2026

Plan of correction: Licensee state they will post the notice and all the requirements for HSC1569.38(e)(1)-(4). They will send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date May 21, 2026.

Type of visit: Required - 1 Year

On May 4, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Eleazar Cuyson and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for five (5) residents. The facility is a two-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, six (6) bathrooms, living area, dining area, living room, kitchen, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Cuyson. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Staff room #1 is on the second story of the facility building. LPA observed Resident #1 (R1) had a hospital bed with half rails, Resident #2 (R2) had a hospital bed, and Resident#3 (R3) had a hospital bed. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 115.5 degrees F to 122.5 degrees F. LPA observed R2's bathroom hot water temperature measure at 122.5 degrees F. A comfortable temperature of 74 degrees maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE) stored in the garage. All mandated inspection control posters were posted. A working telephone (949-490-4062) and an internet accessible device dedicated to the residents that can do video teleconference which both remain available. Last emergency drill was conducted on April 1, 2026. First aid kit is maintained and contains all the necessary elements. Evidence of liability insurance is effective April 8, 2026, and expires on April 8, 2027. Emergency food, emergency water, and emergency supplies are stored in the garage. There are two fire extinguishers mounted in the facility. The resident hallway fire extinguisher and the kitchen fire extinguisher were both serviced on March 23, 2026. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S4), and medication and medication administration record. LPA observed R1 did not have a physician's order for half rails and a hospital bed, R2 did not have a physician's order for their hospital bed, and R3 did not have a physician's order for their hospital bed. LPA Kim conducted interviews with three (3) staff and two (2) residents. Deficiencies were cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed R2's bathroom hot water measured at 122.5 degrees F during the visit. The facility fixed the hot water temperature and it measured at 112. 2 degrees F. LPA observed R1, R2, and R3 did not have a physician's order for their hospital beds. R1 does not have an physician's order for half rails. A Civil Penalty was assessed in the amount of $250.00, during the visit for repeat violation for a deficiency originally cited on a visit March 2, 2026, for hot water temperature not being within 105.0 degrees F and 120.0 degrees F. An exit interview was conducted, and a copy of this report, LIC809D, LIC811, LIC421FC, and appeal rights were provided to Administrator Eleazar Cuyson.the state’s words, verbatim · CDSS document, May 4, 2026

Type of visit: Case Management - Health Checks

On May 4, 2026, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. Upon arrival at the facility, LPA Kim met with Administrator Eleazar Cuyson and explained the purpose of the visit. LPA Kim conducted a health and safety check with ADMIN Cuyson. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to five residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The indoor temperature measured at 74 degrees F. All smoke detectors and carbon monoxide detectors were operational. The fire extinguisher mounted in the kitchen and in the hallway were last serviced on March 23, 2026. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. The backyard and the front yard grass has been mowed today during the visit. All staff on LIC 500 are cleared and associated to the facility. LPA conducted interviews with two residents and four staff. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA Kim reviewed and received copies of the facility staff roster and resident roster. Certificate of Liability insurance is effective on April 8, 2026, to April 8, 2027. An exit interview was conducted, and a copy of this report was provided to Caregiver Angelo Sanguyo.the state’s words, verbatim · CDSS document, May 4, 2026

Type of visit: Case Management - Health Checks

On April 14, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim was greeted and granted entry by Caregiver (CG) Angelo Sanguyo. LPA Kim spoke with Administrator (ADMIN) Eleazar Cuyson over the telephone and explained the purpose of the visit. ADMIN Cuyson could not make it for today's visit and stated that CG Sanguyo could sign on behalf of the facility. LPA Kim conducted a health and safety check with CG Sanguyo. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to five residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature measured between 106.4 degrees F and 116.9 degrees F. The indoor temperature measured at 75 degrees F. All smoke detectors and carbon monoxide detectors were operational. The fire extinguisher mounted in the kitchen and in the hallway were last serviced on March 23, 2026. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. The backyard and the front yard grass has been mowed recently. All staff on LIC 500 are cleared and associated to the facility. LPA conducted interviews with two residents and two staff. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA Kim reviewed and received copies of the facility staff roster and resident roster. Staff stated they have been paid all salary. Certificate of Liability insurance is effective on April 8, 2026, to April 8, 2027. No deficiencies were cited during the visit. . An exit interview was conducted, and a copy of this report was provided to Caregiver Angelo Sanguyo.the state’s words, verbatim · CDSS document, Apr 14, 2026

Type of visit: Case Management - Health Checks

On April 3, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit. LPA introduced self, explained the reason for the visit, and was granted entry into the facility by Licensee Maricel Nepomuceno, who was present to assist. During today’s inspection, LPA conducted a tour of the physical plant with staff and observed the following: There are currently four residents in care with three staff present. Residents were observed watching television and some sleeping with no concerns. Property utilities are operational, including gas, water, and electricity. Bathroom faucets are verified to dispense hot water between 111.5 and 114.2 degrees F. The kitchen was observed clean and the facility has a two day supply of perishable and seven day supply of nonperishable food items available. Emergency food and water supplies were available in the garage. Interviews were conducted with two residents and three staff. All staff stated they are being paid by check on a weekly basis, were last paid on April 2, 2026, and there are no outstanding wages. Residents stated there have been no interruption in utilities, meals are provides on a regular basis, and staff are always present to assist with care needs. Based on today's observations, no deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Licensee Maricel Nepomuceno, and a copy of this report provided at exit.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Case Management - Health Checks

On March 26, 2026, at 12:00 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim was greeted and granted entry by Caregiver (CG) Angelo Sanguyo, LPA Kim spoke with Administrator (ADMIN) Eleazar Cuyson over the telephone and explained the purpose of the visit. ADMIN Cuyson could not make it for today's visit and stated that CG Sanguyo could sign in behalf of the facility. LPA Kim conducted a health and safety check. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to four residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature measured between 107.9 degrees F and 116.6 degrees F. The indoor temperature measured at 75 degrees F. All smoke detectors and carbon monoxide detectors were operational. The fire extinguisher mounted in the kitchen and in the hallway were last serviced on March 23, 2026. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. The backyard and the front yard grass has been mowed recently. All staff on LIC 500 are cleared and associated to the facility. LPA conducted interviews with two residents and two staff. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA Kim reviewed and received copies of the facility staff roster and resident roster. Staff stated they have been paid all salary. The facility still has not provided a valid and current liability insurance. Evaluation Report Continues on LIC 809-C A deficiency was cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. The Licensee is receiving the same citation that was issued during a previous visit conducted on March 2, 2026. The Licensee has not corrected the deficiency for not having a current and valid insurance. A Civil Penalty was assessed in the amount of $800.00, during the visit for repeat violation for failure to correct a deficiency originally cited on a visit March 2, 2026, for not having a valid and current liability insurance. An exit interview was conducted, and a copy of this report, LIC809D, LIC421FC, and appeal rights were provided to Caregiver Angelo Sanguyo.the state’s words, verbatim · CDSS document, Mar 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Mar 27, 2026

HSC1569. 605 .... all residential care facilities for the elderly, ... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on observation, record review and interviews, the licensee did not comply with the section cited above. The facility did not have an active or current insurance. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: Licensee states they will provide a current insurance to CCLD via email to edward.kim@dss.ca.gov by POC due date March 26, 2026.

Type of visit: Case Management - Health Checks

On March 18, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim was greeted and granted entry by Caregiver (CG) Angelo Sanguyo, LPA Kim spoke with Administrator (ADMIN) Eleazar Cuyson over the telephone and explained the purpose of the visit. ADMIN Cuyson could not make it for today's visit and stated that CG Sanguyo could sign in behalf of the facility. LPA Kim conducted a health and safety check. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to four residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature measured between 106.1 degrees F and 113.8 degrees F. The indoor temperature measured at 75 degrees F. All smoke detectors and carbon monoxide detectors were operational. The fire extinguisher mounted in the kitchen was last serviced on February 25, 2025, and the resident hallway was last serviced on February 26, 2025. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. The backyard and the front yard have overgrown grass. All staff on LIC 500 are cleared and associated to the facility. LPA conducted interviews with two residents and four staff. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. Staff stated they have been paid all salary.. Evaluation Report Continues on LIC 809-C LPA Kim reviewed and received copies of the facility staff roster and resident roster. The facility still has not provided a valid and current liability insurance. A Civil Penalty was assessed in the amount of $700.00, during the visit for repeat violation for failure to correct a deficiency originally cited on a visit March 2, 2026, for not having a valid and current liability insurance. An exit interview was conducted, and a copy of this report and LIC 421FC were provided to Caregiver Angelo Sanguyo.the state’s words, verbatim · CDSS document, Mar 18, 2026

Type of visit: Case Management - Health Checks

On March 11, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim was greeted and granted entry by Caregiver (CG) Angelo Sanguyo, LPA Kim spoke with Administrator (ADMIN) Eleazar Cuyson over the telephone and explained the purpose of the visit. ADMIN Cuyson could not make it for today's visit and stated that CG Sanguyo could sign in behalf of the facility. LPA Kim conducted a health and safety check. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to four residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature measured between 105.0 degrees F and 116.4 degrees F. The indoor temperature measured at 75 degrees F. All smoke detectors and carbon monoxide detectors were operational. The fire extinguishers mounted in the kitchen and the resident hallway were last serviced on February 25, 2025. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. The backyard and the front yard have overgrown grass. All staff on LIC 500 are cleared and associated to the facility. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. Staff stated they have not been paid since February 4, 2026, to the present. Evaluation Report Continues on LIC 809-C LPA Kim reviewed and received copies of the facility staff roster and resident roster. LPA conducted interviews with two staff, three residents, and one witness. The facility still has not provided a valid and current liability insurance and have still not provided an evacuation chair for the second floor. Deficiencies were cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA Kim observed the fire extinguishers mounted in the kitchen and resident hallway were last inspected on February 25, 2025. The facility has not provided payment to staff and provided staff salary records to CCLD. Civil Penalties were assessed during the visit for repeat violations for failure to correct on a March 2, 2026 visit for not having a valid liability insurance and not having an evacuation chair at the facility. An exit interview was conducted, and a copy of this report, LIC809D, LIC 421FC, and appeal rights were provided to Caregiver Angelo Sanguyo.the state’s words, verbatim · CDSS document, Mar 11, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 12, 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 immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 11, 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 March 12, 2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Mar 20, 2026

87303(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 is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. LPA Kim observed the fire extinguishers mounted in the kitchen and in the hallway with an inspection date of February 25, 2025. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 11, 2026

Plan of correction: Licensee states they will send evidence of valid and compliant fire extinguishers by email to CCLD via edward.kim@dss.ca.gov by POC due date March 20, 2026.

Type of visit: Case Management - Health Checks

On March 2, 2026, at 1:40 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim met with Administrator (ADMIN) Eleazar Cuyson and explained the purpose of the visit. LPA Kim conducted a health and safety check. During the visit, LPA toured the facility and observed the following: LPA observed one staff on duty providing care to four residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature measured between 105.0 degrees F and 122.1 degrees F. The indoor temperature measured at 75 degrees F. All smoke detectors and carbon monoxide detectors were operational. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. The backyard and the front yard have overgrown grass. The two outdoor gates were locked with a padlock. The facility removed both padlocks during the visit. All staff on LIC 500 are cleared and associated to the facility. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA Kim reviewed and received copies of the facility staff roster and resident roster LPA conducted interviews with one staff, three residents, and one witness. Evaluation Report Continues on LIC 809-C Deficiencies were cited during the visit per Title 22 Division 6 Chapter 3.2 of the Health and Safety Code and Title 22 Division 6 Chapter 8 of the California Code of Regulations. Facility did not have a valid and active insurance. The facility does not have an evacuation chair for the second floor at the facility. The hot water temperature measured at 122.1 degrees F in the common resident bathroom. The facility locked the two outdoor gates with a padlock. Civil Penalties were assessed during the visit for repeat violations for failure to correct and repeat deficiency for Fire Clearance. An exit interview was conducted, and a copy of this report, LIC809D, and appeal rights were provided to Administrator Eleazar Cuyson.the state’s words, verbatim · CDSS document, Mar 2, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Mar 3, 2026

HSC1569. 605 .... all residential care facilities for the elderly, ... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on observation, record review and interviews, the licensee did not comply with the section cited above. The facility did not have an active or current insurance. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 2, 2026

Plan of correction: Licensee states they will provide a current insurance to CCLD via email to edward.kim@dss.ca.gov by POC due date March 3, 2026. Civil Penalty assessed for Immediate violation.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.695(f)(1) · Plan of correction due date: Mar 3, 2026

An evacuation chair at each stairwell, on or before July 1, 2019. This requirement is not being met as evidenced by; LPA observed there is no evacuation chair next to the stairway. This poses an immediate health and safety risk to residents, staff and visitors.the state’s words, verbatim · CDSS document, Mar 2, 2026

Plan of correction: Licensee states to have an evacuation chair mounted at the top of the staircase and send proof of completed POC to CCLD via email to edward.kim@dss.ca.gov by POC due date March 3, 2026. Civil Penalty assessed for repeat violation.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87203 · Plan of correction due date: Mar 3, 2026

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observation, interviews, and record review, the licensee did not comply with the section cited above. LPA observed and took photos of both exterior gates being locked with a padlock. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 2, 2026

Plan of correction: Deficiency cleared during the visit. The facility removed both padlocks during the visit. Civil Penalty assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(e)(2) · Plan of correction due date: Mar 3, 2026

87303(e)(2) Faucets used by residents... shall deliver hot water. Hot water temperature controls shall be maintained... to attain a temperature of not less than 105 degree F... and not more than 120 degrees... This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above. LPA observed the water temperature in the common resident bathroom measure at 122.7 degrees F. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 2, 2026

Plan of correction: Licensee stated they will adjust the temperature to be in compliance and send proof of completion to CCLD via email to edward.kim@dss.ca.gov by POC due date March 3, 2026.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced Case Management visit to conduct a health and safety check on the residents in care. LPA was greeted and granted entry by Staff. The Administrator Eleazar Cuyson was notified by phone that LPA was at the facility. LPA asked if the facility had current liability insurance, Administrator stated that is it being taken care of by the Licensee and it should be acquired by Friday February 27, 2026. LPA verified with the Administrator that at this time the facility does not have insurance. The Administrator's certificate expires May 27, 2026. LPA and Staff toured the facility. Facility room temperature was 74.3 degrees Fahrenheit in the living room. LPA observed the See Something Say Something sign (PUB 475) posted in the living room. LPA observed the 5 burner gas stove lights unassisted. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The kitchen is clean and organized. The fire extinguisher in the dining is room is fully charged. LPA interviewed 1 resident. Resident reported they have no issues and are doing well. 1 resident was not at the facility and 1 resident was asleep. LPA interviewed Staff 1 and Staff 2. Both staff members reported they are doing well and have no issues. Both staff members are background cleared and associated to the facility. LPA observed the bathrooms are clean and operational. Hot water measured 116.2 degrees Fahrenheit in the shared bathroom next to the living room. LPA observed all resident rooms had the required furnishings. LPA observed all resident rooms are clean and all beds have clean linen. Smoke detectors/carbon monoxide detectors tested operational. LPA and staff toured the upstairs. The upstairs has a loft and a staff bedroom and bathroom. No residents reside upstairs. LPA observed there is no evacuation chair next to the stairway. LPA observed the loft has a sofa and table. LPA toured the backyard. LPA observed there is a storage building in the backyard. LPA observed old furniture and boxes in the storage building. No bodies of water observed. Both exit gates on each side of the facility are operational. No obstacles or hazards observed in the backyard. LPA and staff toured the garage. The garage is kept locked and used for storage. Staff reported that residents do no go into the garage. No obstacles or hazards observed inside or outside of the facility. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and Health and Safety Code. A Civil Penalty of $250 is being assessed for Failure to Correct/Repeat Violation. An exit interview was conducted and a copy of this report was given to the facility along with a copy of the, LIC 421-FC, LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Feb 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Feb 25, 2026

HSC1569. 605 .... all residential care facilities for the elderly, ... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as 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 24, 2026

Plan of correction: Licensee agrees to have the required insurance and to provide proof to the Agency (CCL) by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.695(f)(1) · Plan of correction due date: Feb 25, 2026

An evacuation chair at each stairwell, on or before July 1, 2019. This requirement is not being met as evidenced by; LPA observed there is no evacuation chair next to the stairway. This poses an immediate health and safety risk to residents, staff and visitors.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee agrees to have an evacuation chair mounted at the top of the staircase by the POC due date. Licensee to forward proof of correction to LPA by POC due date.

Type of visit: Case Management - Health Checks

On February 5, 2026, at 1:30 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim met with Administrator (ADMIN) Eleazar Cuyson and explained the purpose of the visit. LPA Kim conducted a health and safety check with ADMIN Cuyson. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to four residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The hot water temperature measured between 105.0 degrees F and 110.1 degrees F. The indoor temperature measured at 75 degrees F. All smoke detectors and carbon monoxide detectors were operational. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949) 490-4062 was tested and remains available. Utilities are all in working order as well as kitchen appliances. No obstacles or hazards observed in the backyard. All staff on LIC 500 are cleared and associated to the facility. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA Edward Kim received an email from Licensee Maricel Nepomuceno which stated that the facility does not have a current insurance in place. The Licensee owns sixteen facilities in Orange County and are in financial distress in regard to utility payments, lease agreement payments, and other financial issues. The facility has two residents with mild cognitive impairment, one with dementia, and have three residents who needs assistance to move throughout the facility with supervision. The residents at this facility have serious concerns based on their condition and level of care. Evaluation Report Continues on LIC 809-C LPA Kim reviewed and received copies of the facility staff roster, resident roster, and resident records of four (4) residents which included each resident's facesheet, admission agreement, physician report, and reappraisal. LPA Kim reviewed and receive will email the previous three months of the facility's electricity bills and payments, facility’s gas bills and payments, facility’s water bills and payments, and the facility’s waste management bills and payments. LPA conducted interviews with three staff and three residents. A deficiency was cited during the visit per Title 22 Division 6 Chapter 3.2 of the Health and Safety Code LPA observed in an email received by the Licensee Maricel Nepomuceno that the facility does not have current insurance in place. An exit interview was conducted, and a copy of this report, LIC809D, and appeal rights were provided to Administrator Eleazar Cuyson.the state’s words, verbatim · CDSS document, Feb 5, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Feb 13, 2026

HSC1569. 605 .... all residential care facilities for the elderly, ... shall maintain liability insurance covering injury to residents and guests... This requirement is not met as evidenced by: Based on observation, record review and interviews, the licensee did not comply with the section cited above. LPA Kim received an email where Licensee stated the facility does not have current insurance. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 5, 2026

Plan of correction: Licensee states they will provide a current insurance to CCLD via email to edward.kim@dss.ca.gov by POC due date February 13, 2026.

Type of visit: Case Management - Health Checks

On January 5, 2026, at 2:15 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim met with Administrator (ADMIN) Eleazar Cuyson and explained the purpose of the visit. LPA Kim conducted a health and safety check . Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Resident hygiene supplies in their bathrooms and extra supplies in the garage. The hot water/indoor temperature measured was within the required range. All smoke detectors and carbon monoxide detector were operational. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949)490-4062, was tested and remains available. LPA observed one staff on duty providing care to four residents. Deficiencies were cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA Kim observed two (top left and top right) out of four kitchen stove burners were not operational during today's visit. LPA Kim observed a power drill left unattended on an office desk next to the resident hallway. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Eleazar Cuyson.the state’s words, verbatim · CDSS document, Jan 5, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jan 6, 2026

87309(a) ...the licensee shall ensure that .... knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above. LPA Kim observed a power drill left out on the office desk in the resident hallway. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 5, 2026

Plan of correction: Deficiency cleared during the visit. Licensee placed the power drill in a locked area and will ensure that all sharps, tools, and other dangerous items are locked up.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Jan 19, 2026

87303(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 is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above. LPA Kim observed two (top left and top right) out of four kitchen stove burners were not lighting unassisted during today's visit. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 5, 2026

Plan of correction: Licensee states they will send a photo and video of all four burners lighting unassisted by email to CCLD via edward.kim@dss.ca.gov by POC due date January 19, 2026.

Type of visit: Case Management - Health Checks

On November 4, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted a case management visit for the purpose of conducting a health and safety check and requesting documentation. LPA was greeted by facility staff Cathyrine Manalastas, explained the reason for the visit, and granted entry into the facility. LPA spoke with Director of Operations (DO) Joanna Gomez via telephone to discuss the reason for the visit. During the call, LPA requested documents and DO stated emails would be sent to LPA today, with the requested documentation included. During the visit, LPA toured the facility with staff and observed no health and safety issues. The facility is in good repair. Property utilities are operational, including gas, water, and electricity. Perishable and non-perishable food supply was observed adequately stocked at time of visit. Three out of six residents have special diets that the facility is following. Based on the observations made during today’s inspection, no deficiencies are being cited at this time. Records are being reviewed and deficiencies may be cited during a subsequent visit. An exit interview was conducted with staff Cathyrine Manalastas, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Case Management - Health Checks

On June 16, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim was greeted and granted entry by Caregiver (CG) Cathyrine Manalastas. Administrator (ADMIN) Rosendo Carlo Miranda arrived at the facility at 8:30 AM and LPA explained the purpose of the visit. LPA Kim conducted a health and safety check with ADMIN Miranda. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Resident hygiene supplies in their bathrooms and extra supplies in the garage. LPA Kim observed one meal service at 8:30 AM. Residents were served pancakes, spam, with water and coffee or orange juice. The hot water/indoor temperature measured was within the required range. All smoke detectors and carbon monoxide detector were operational. All emergency disaster supplies were prepared and available in the garage. Facility land line, (949)-490-4062, was tested and remains available. LPA observed two staff on duty providing care to five residents. A deficiency was cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. The licensing fees were due on May 6, 2025, and were not paid as of June 16, 2025. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Rosendo Carlo Miranda.the state’s words, verbatim · CDSS document, Jun 16, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87156(a) · Plan of correction due date: Jun 30, 2025

87156(a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. This requirement is not met as evidenced by: Based on observation, interviews, and record review, the licensee did not comply with the section cited above. As of June 16, 2025, LPA Kim observed the licensing fees due May 6, 2025, were not paid. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 16, 2025

Plan of correction: Licensee states they will pay the annual licensing fees and send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date June 30, 2025.

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 Vongphakdythe state’s words, verbatim · CDSS document, May 22, 2025

Type of visit: Required - 1 Year

On May 2, 2025, at 8:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Cathyrine Manalastas. Administrator (ADMIN) Rosendo Carlo Miranda arrived around 9:00 AM at the facility and LPA Kim explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for five (5) residents. The facility is a two-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) staff bedroom, six (6) bathrooms, living area, dining area, living room, kitchen, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Miranda. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Staff room #1 is on the second story of the facility building and Staff Room #2 is in a building in the backyard. The facility sketch from fire clearance record designates staff room #2 as an office and storage building. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 106.1 degrees F to 110.5 degrees F. A comfortable temperature of 71 degrees maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. There are three fire extinguishers mounted in the facility. The resident hallway fire extinguisher was serviced on February 26, 2025, the kitchen fire extinguisher was serviced on February 25, 2025, and the garage fire extinguisher was serviced October 3, 2024. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE) stored in the garage. All mandated inspection control posters were posted. A working telephone (949-490 -4062) and an internet accessible device dedicated to the residents that can do video teleconference which both remain available. Last emergency drill was conducted on March 1, 2025. First aid kit is maintained and contains all the necessary elements. Evidence of liability insurance is effective September 1, 2024, and expires on September 1, 2025. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S7), and medication and medication administration record that were all in order and complete. LPA Kim conducted three (3) resident interviews. A Deficiency was cited during this inspection visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. Staff Room #2 is a building in the backyard that is designated as a storage and office building and not as a bedroom. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Rosendo Carlo Miranda.the state’s words, verbatim · CDSS document, May 2, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the second pre-licensing visit. LPA met with Administrator Rosendo Carlo Miranda and explained the reason for the visit. LPA toured the facility with the Administrator. LPA verified that the evacuation chair has been installed at the top of the staircase to the second floor. No deficiencies observed during the visit. The facility is ready to be licensed. Administrator was informed today that the final approval will be processed by CAB (Central Applications Bureau) in Sacramento. For more information concerning the pre-licensing inspection visit please see the LIC 809 dated April 19, 2024. Exit interview was conducted and a copy of this report was left with the Administrator.the state’s words, verbatim · CDSS document, Apr 22, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the pre-licensing inspection. LPA met with applicant Maricel Nepomuceno and Administrator Rosendo Carlo Miranda An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to CCL on August 29, 2023. The facility is to have a capacity of 6, of which 6 can be nonambulatory and zero bedridden. Applicant has requested a hospice waiver for 6 residents. Facility phone number 949-490-4062. This is a change of ownership. There are 5 residents in care at the facility. LPA observed the following. Structure: The facility is a two story house with an attached 2 car garage with 6 bedrooms (1 is for staff, upstairs), 6 bathrooms, 1 dining room, a kitchen and living room. There are 7 exits, one exit door in each downstairs bedroom, the front door, and an exit door in the main hallway by the staircase. The facility is a two-story home. LPA did not observe an evacuation chair mounted next to the top of the stairway. Air/Heating: The facility has a central heating system. Each resident room has it's own air conditioner. Resident Bedrooms: There are 5 Resident Bedrooms. Room number 2 is a shared room. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings. Bedrooms Staff: The second floor bedroom is the designated staff bedroom. Bathrooms: All 6 bathrooms are clean and operational. Linens & Hygiene Supplies: Adequate supply of linen stored in the hallway cabinet. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food served for one week. Food Service: There is a 2 day perishable and a 7-day non-perishable food supply on hand in the kitchen. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors tested operational. There are 3 fire extinguishers in the facility. 1 is mounted on the wall next to the kitchen. 1 is in the garage and one is in the hallway next to the stairway. Appliances: There is one 4 gas burner stove which lights unassisted, 1 oven, microwave oven on the kitchen counter, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All cleaning supplies and chemicals are kept in two areas: kitchen cleaning supplies locked under the kitchen sink and all extra cleaning supplies are locked in the garage. The garage is kept locked and used for storage. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 109.4 to 113.7 degrees Fahrenheit. Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in the hallway cabinet next to the stairway. The first aid kit has all the required elements. Medications are kept locked in the hallway cabinet next to the stairway. Resident & Staff Files: The Resident and Staff Records are kept locked in the cabinet in the hallway next to the stairs. Reading Material, Games, Equipment & Materials: Arts and craft, tablet, and board games are stored in the hallway next to the stairs and in the living room. There is a large screen TV mounted in the living room. Fire clearance: Fire clearance was approved on March 19, 2024 by Newport Beach Fire Department fire inspector Nadine Morris. Backyard: LPA observed there is a shaded seating area with a table, 4 chairs and an umbrella. There is a storage building in the backyard that is kept locked. LPA observed old furniture and wheelchairs in the storage building. No obstacles or hazards observed in the backyard. Both exit gates are latched and self-closing. Each exit gate has a working auditory alarm that sounds when the gates are opened. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. The facility is not ready to be licensed. The Applicant was informed to contact the LPA to schedule the next pre-licensing inspection when the evacuation chair has been installed. Applicant was informed today that the final approval will be processed by CAB (Central Applications Bureau) in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Apr 19, 2024