The Hills of Sierra Chula

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. LPA arrived at facility and rang the doorbell, with no answer. LPA called Administrator Shaleemar Balignasay and Licensee Maricel Nepomuceno with no availability. LPA observed all window of the windows in the facility had no shades and the interior was visible from the outside . For this visit LPA toured the outside of the exterior portion of the facility from the outside. LPA was able to verify the house was empty with minimal furnishings in the kitchen only. Resident room are empty and very minimal furnishings, none had a bed in them. LPA observed the facility to be empty and there was no indication that there were any residents. LPA observed the facility to have running water. As of today's date the facility remains empty with no residents in care and no indications that the house is used to provide care to residents. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. LPA left a message to both the Administrator and Licensee in regards to the visit and further information. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. Copy of this report was left at facility mail box and will make it available to licensee.the state’s words, verbatim · CDSS document, Aug 25, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. Shaleemar Balignasay, Administrator met with LPA. LPA observed the landlord of the facility to beat the premises doing remodeling. LPA was granted access to the facility and LPA was able to enter the facility. LPA took a tour of the physical plant of the facility. LPA observed the facility to be empty and there was no indication that there were any residents. LPA observed the facility still had running water but no power. LPA did not observed any food supplies. As of today's date the facility remains empty with no residents in care and no indications that the house is used to provide care to residents. LPA observed the facility to have minimal furnishings and resident bedrooms to be empty. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. Licensee to contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of was provided to the facility.the state’s words, verbatim · CDSS document, Aug 3, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. Shaleemar Balignasay, Administrator met with LPA. LPA observed all window of the facility had the shades closed. LPA was granted access to the facility and LPA was able to enter the facility. LPA took a tour of the physical plant of the facility. LPA observed the facility to be empty and there was no indication that there were any residents. LPA observed the facility still had running water but no power. LPA did not observed any food supplies. As of today's date the facility remains empty with no residents in care and no indications that the house is used to provide care to residents. LPA observed the facility to have minimal furnishings and resident bedrooms to be empty. Caregiver was unsure if the facility will be occupied or renovated for now, but that is unclear for now if and when that will happen. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. Licensee to contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license. As noted Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following: An updated Personnel Report (LIC 500) and Copy of Administrator Certificate. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of was provided to the facility.the state’s words, verbatim · CDSS document, Jul 14, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. LPA arrived at facility and rang the doorbell, with no answer. Rosendo Miranda, Administrator arrived to the facility and explained the purpose of visit. LPA observed all window of the facility had the shades closed. LPA was granted access to the facility and LPA was able to enter the facility. LPA took a tour of the physical plant of the facility. LPA observed the facility to be empty and there was no indication that there were any residents. LPA observed the utilities were still operational and minimal food supply was in pantry. LPA observed the facility to have running water and hot water measured 114.8 degrees Fahrenheit. As of today's date the facility remains empty with no residents in care and no indications that the house is used to provide care to residents. LPA observed the facility to have minimal furnishings and resident bedrooms to be empty. Caregiver was unsure if the facility will be occupied or renovated for now, but that is unclear for now if and when that will happen. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. Licensee to contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license. As noted Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following: An updated Personnel Report (LIC 500) and Copy of Administrator Certificate. LPA requested additional documents due by July 6, 2026 to be mailed or emailed to LPA. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of was provided to the facility.the state’s words, verbatim · CDSS document, Jun 23, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. LPA arrived at facility and rang the doorbell, with no answer. LPA spoke to Eleazar Cuyson, Administrator and explained the purpose of visit. Mhike Escario, caregiver arrived shortly after and met with LPA. LPA observed all window of the facility had the shades closed. LPA was granted access to the facility and LPA was able to enter the facility. LPA took a tour of the physical plant of the facility. LPA observed the facility to be empty and there was no indication that there were any residents. LPA observed the utilities were still operational and minimal food supply was in pantry. LPA observed the facility to have running water and hot water measured 118.2 degrees Fahrenheit. As of today's date the facility remains empty with no residents in care and no indications that the house is used to provide care to residents. LPA observed the facility to have minimal furnishings and resident bedrooms to be empty. Caregiver was unsure if the facility will be occupied or renovated for now, but that is unclear for now if and when that will happen. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. Licensee to contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license. As noted Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following: An updated Personnel Report (LIC 500) and Copy of Administrator Certificate. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of was provided to the facility.the state’s words, verbatim · CDSS document, Jun 2, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. LPA arrived at facility and rang the doorbell, with no answer. LPA called Administrator Eleazar Cuyson with no answer. Administrator sent LPA a message that he is unable to meet LPA at facility he will send a care staff to meet LPA. Mhike Escario, caregiver arrived shortly after and met with LPA. LPA observed all window of the facility had the shades closed. Caregiver granted access to LPA and LPA was able to enter the facility. LPA accompanied by caregiver took a tour of the physical plant of the facility. LPA observed the facility to be empty and there was no indication that there were any residents. LPA observed the utilities were still operational and minimal food supply was in pantry. As of today's date the facility remains empty with no residents in care and no indications that the house is used to provide care to residents. LPA observed the facility to have minimal furnishings and resident bedrooms to be empty. Caregiver was unsure if the facility will be occupied or renovated for now, but that is unclear for now if and when that will happen. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. Licensee to contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license. As noted Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following: An updated Personnel Report (LIC 500) and Copy of Administrator Certificate. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of was provided to the facility.the state’s words, verbatim · CDSS document, May 19, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. LPA arrived at facility and rang the doorbell, with no answer. LPA called Administrator Eleazar Cuyson and informed him of the visit. Administrator arrive at facility and met with LPA. LPA observed all window of the facility had the shades closed. LPA observed the front door was open and LPA took a tour of the physical plant of the facility. LPA observed the facility to be empty and there was no indication that there were any residents. Residents were relocated to another one of the licensees licensed facilities. As of today's date the facility remains empty with no residents in care and no indications what the house is used to provide care to residents. LPA observed the facility to have minimal furnishings and resident bedrooms to be empty. Administrator stated that the licensee had no plans to move residents back into the facility for now. Facility might undergo a few renovations, but that is unclear for now if and when that will happen. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 was provided to the facility.the state’s words, verbatim · CDSS document, May 4, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. LPA arrived at facility and rang the doorbell, with no answer. LPA observed all window of the facility had the shades closed. LPA called Eleazar Cuyson, Administrator and informed him of the visit. Administrator arrived at the facility and met with LPA. LPA observed the front door was open and LPA took a tour of the physical plant of the facility. LPA observed the facility to be empty and there was no indication that there were any residents. LPA was informed on April 2, 2026 that residents would be relocated to another one of the licensees licensed facilities. As of today's date the facility remains empty with no residents in care and no indications what the house is used to provide care to residents. LPA observed the facility to have minimal furnishings and resident bedrooms to be empty. Administrator stated that the licensee had no plans to move residents back into the facility and the current CHOW application was still in process. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 was provided to the facility.the state’s words, verbatim · CDSS document, Apr 21, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. LPA arrived at facility and rang the doorbell, with no answer. LPA observed all window of the facility had the shades closed. LPA was able to observe by the window by front door home was empty and there was no indication that there were any residents. LPA called Administrator Eleazar Cuyson and was informed that all residents had been moved out of the facility and relocated to one of their other licensed facilities. Administrator arrived shortly after and met with LPA. LPA conducted a case management visit on April 02, 2026, and was informed by caregiver that there was a possibility that the 3 residents in care would be relocated to another of the Licensees licensed facilities in the upcoming weeks. LPA spoke to Licensee Maricel Nepomuceno which indicated that facility would be going through a CHOW application and during the process Licensee decided to move the residents to one of their other licensed facilities, based on the residents preference. LPA toured the physical plant of the facility and did not observe any residents in care. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 was provided to the facility.the state’s words, verbatim · CDSS document, Apr 7, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility to conduct a Case Management - Health Check. LPA observed three residents in care and two caregivers present. LPA observed residents to be in clean clothes. LPA conducted a tour of the physical plant. LPA inspected the five 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 the lights in each of the resident bedrooms to be operational. Bathrooms were equipped with grab bars and non-skid floor mats. LPA measured the hot water at 106.7 degrees Fahrenheit in facility bathrooms. 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. Facility has an additional food supply in the spare refrigerator located in the garage. LPA observed a first aid kit, emergency water supply and emergency food bucket stored in the closet adjacent to garage. LPA observed all of the facilities utilities to be operational during the visit. Sharps and medications are secured. Fire extinguishers are fully charged with service date of March 23, 2026. Smoke detector/ carbon monoxide detectors are operational during today's visit. LPA toured the backyard, no bodies of water observed. There is a shaded seating area in the front yard and backyard for residents to sit. The exit gates are operational. No obstacles or hazards observed in the backyard. All staff present are background cleared and associated to the facility. LPA observed all of the facilities utilities to be operational during the visit. No health or safety concerns were observed. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this LIC809 was provided to the facility.the state’s words, verbatim · CDSS document, Apr 2, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility to conduct a Case Management - Health Check. LPA observed three residents in care and two caregivers present. LPA observed residents to be in clean clothes. LPA conducted a tour of the physical plant. LPA inspected the five 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 the lights in each of the resident bedrooms 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. LPA measured the hot water at 106.8 degrees Fahrenheit in facility bathrooms. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. Facility has an additional food supply in the spare refrigerator located in the garage. LPA observed a first aid kit, emergency water supply and emergency food bucket stored in the closet adjacent to garage. LPA observed all of the facilities utilities to be operational during the visit. Sharps and medications are secured. Fire extinguishers are fully charged with service date of March 23, 23, 2026. Smoke detector/ carbon monoxide detectors are operational during today's visit. LPA toured the backyard, no bodies of water observed. There is a shaded seating area in the front yard and backyard for residents to sit. The exit gates are operational. No obstacles or hazards observed in the backyard. All staff present are background cleared and associated to the facility. No health or safety concerns were observed. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 was provided to the facility.the state’s words, verbatim · CDSS document, Mar 25, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility to conduct a Case Management - Health Check. LPA observed three residents in care and two caregivers present. LPA observed residents to be in clean clothes. LPA conducted a tour of the physical plant. LPA inspected the five 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 the lights in each of the resident bedrooms 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. LPA measured the hot water at 111.2 degrees Fahrenheit in facility bathrooms. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. Facility has an additional food supply in the spare refrigerator located in the garage. LPA observed a first aid kit, emergency water supply and emergency food bucket stored in the closet adjacent to garage. LPA observed all of the facilities utilities to be operational during the visit. Sharps and medications are secured. Fire extinguishers are fully charged with service date of April 9, 2025. Smoke detector/ carbon monoxide detectors are operational during today's visit. LPA toured the backyard, no bodies of water observed. There is a shaded seating area in the front yard and backyard for residents to sit. The exit gates are operational. No obstacles or hazards observed in the backyard. All staff present are background cleared and associated to the facility. No health or safety concerns were observed. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 was provided to the facility.the state’s words, verbatim · CDSS document, Mar 18, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA observed three residents in care and two caregivers present. LPA observed residents to be in clean clothes. LPA conducted a tour of the physical plant. LPA inspected the five 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 the lights in each of the resident bedrooms 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. LPA measured the hot water at 109.8 degrees Fahrenheit in facility bathrooms. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. Facility has an additional food supply in the spare refrigerator located in the garage. LPA observed a first aid kit, emergency water supply and emergency food bucket stored in the closet adjacent to garage. LPA observed all of the facilities utilities to be operational during the visit. Sharps and medications are secured. Fire extinguishers are fully charged with service date of April 9, 2025. Smoke detector/ carbon monoxide detectors are operational during today's visit. LPA toured the backyard, no bodies of water observed. There is a shaded seating area in the front yard and backyard for residents to sit. The exit gates are operational. No obstacles or hazards observed in the backyard. All staff present are background cleared and associated to the facility. No health or safety concerns were observed. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 was provided to the facility.the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez 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 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 conducted a tour of the physical plant. LPA inspected the five 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 the lights in each of the resident bedrooms 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 hot water measured 109.8 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. Facility has an additional food supply in the spare refrigerator located in the garage. LPA observed a first aid kit, emergency water supply and emergency food bucket stored in the closet adjacent to garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. Sharps and medications are CONTINUED ON LIC809-C secured. Fire extinguishers are fully charged with service date of April 9, 2025. Smoke detector/ carbon monoxide detectors are operational during today's visit. During the visit LPA was emailed a copy of the liability insurance with current coverage dates. LPA toured the backyard, no bodies of water observed. There is a shaded seating area in the front yard and backyard for residents to sit. The exit gates are operational. No obstacles or hazards observed in the backyard. All staff present are background cleared and associated to the facility. No health or safety concerns were observed. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 was provided to the facility.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 Eleazar 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, accompanied by a care giving staff, conducted a tour of the physical plant. LPA observed residents to be in clean clothes. LPA inspected the five 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 110.6 to 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 three 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, one staff stated that they have only received partial pay as of today. Two staff stated that they have not received any pay for that pay period, therefore, the Licensees are eleven days behind on the scheduled pay date. Three out of three staff interviewed also stated that they have been paid late in previous pay periods. Two out of the three staff stated that they are owed back pay from previous pay periods. Additionally, all three staff staff reported that they have not received any pay for the first pay period of February 2026, and have not been told when they will be paid for that pay period. LPA observed that the Licensee has not paid the facility's annual fees for the year of 2025 despite previous reminders. The Licensee currently has a balance of $495.00 for the facility's 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, 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. A civil penalty will also be assessed in the amount of $700.00 for failure to correct. The Licensee did not correct a deficiency that was cited on February 17, 2026. An exit interview was conducted with Administrator Eleazar Cuyson via telephone. A copy of the report and Appeal Rights were provided to an authorized facility representative.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: CCR87156(a) · Plan of correction due date: Mar 3, 2026

87156 Licensing Fees: (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. This requirement was not evidenced by: Based on observation and records reviewed, the Licensee did not pay the facility's annual fees for 2025 depsite previous reminders. 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 Licensee stated that he will pay the facility's annual fees. The Licensee agreed to provide LPA proof of payment via email or fax by POC date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to deliver an amended report. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and observed the following: Facility appears clean and sanitary. LPA observed satisfactory food supply and electricity and water is operational today. Residents are relaxing and appear clean. LPA delivered an amended report for complaint #22-AS-20260126160621. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 18, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Ruth Martinez 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 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 conducted a tour of the physical plant. LPA inspected the five 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 the lights in each of the resident bedrooms 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 hot water measured 112.8 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 in the kitchen pantry. Facility has an additional food supply in the spare refrigerator located in the 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 CONTINUED ON LIC809-C staff. During two staff interviews, staff informed LPA that they were supposed to receive their paycheck Friday February 13, 2026, but have not received their pay. LPA was informed that facility still did not have liability insurance. Sharps and medications are secured. Fire extinguishers are fully charged. Smoke detector/ carbon monoxide detectors are operational during today's visit. Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. See LIC809-D for deficiencies. An immediate civil penalty is assessed. This report was reviewed with facility representative and a copy of this LIC809, LIC809-D report was provided and left at facility. Appeal rights reviewed, and a copy provided.the state’s words, verbatim · CDSS document, Feb 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 18, 2026

87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, .. and that assures sufficient resources to meet operating costs for care of residents.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid on schedule. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 17, 2026

Plan of correction: The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay for previous pay that is due, and for pay periods moving forward. the finacial plan shall be submitted via email or fax by POC date. This area was cited on 1/8/26. Due to deficiencies not corrected facility is receiving civil penalty.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Feb 18, 2026

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests...This requirement is not met as evidenced by: Based on observation and interviews the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA was informed Licensee currently does not have liability insurance for the facility.the state’s words, verbatim · CDSS document, Feb 17, 2026

Plan of correction: The Adminstrator/Licensee to provide LPA proof of liability insurance for the facility via email or fax by POC date. This area was cited on 2/13/26. Due to deficiencies not corrected facility is receiving civil penalty.

Type of visit: Required - 1 Year

On February 13, 2026 Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone and later arrived to assist with the inspection. LPA observed that Eleazar Cuyson has a valid Administrator certificate which expires on May 27, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for six. The facility is a single story home with five resident bedrooms, one of which is shared, one staff bedroom, three bathrooms, two of which are dedicated for resident use, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed three residents in care and two care giving staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the five 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 are stored in a hallway cabinet. LPA observed the staff bedroom is kept locked and inaccessible to residents in care. 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 109.9 to 112.2 degrees Fahrenheit. LPA observed the facility currently does not have a minimum two day perishable and a seven non-perishable food supply on hand. LPA observed the facility has a an approximate five day nonperishable food supply on hand. CONTINUED ON LIC809-C Additionally, on duty care giving staff informed LPA that the facility had placed a grocery order on February 10, 2026, via the Walmart grocery app. Care giving staff informed LPA that they needed approval from the Licensee to have the order fulfilled, however, the Licensee has not approved the order, and therefore groceries have not been delivered to the facility. The kitchen is clean and appliances were operational. LPA observed the four top electric stove to be operational at the time of visit. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed toxins and chemicals to be stored in a locked kitchen cabinet under the sink. The centrally stored medication is kept in a locked cabinet in the kitchen. The facility also has first aid kit stored in the kitchen and it has all the required components. There are three fire extinguishers located in the facility. Fire extinguishers were observed to be charged and serviced as of April 9, 2025. LPA tested the dual smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 1, 2026. LPA observed the facility has a three day emergency food and water supply stored in a closet by the garage. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage and laundry. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate of the facility is self-latching and can be open in an evacuation. There are no bodies of water on the premises. LPA reviewed the three residents files. All the required documentation was present and current in the resident file reviewed. LPA reviewed the residents' medication and medication administration record. LPA reviewed four staff files. All staff are background cleared and associated to the facility. LPA observed the Licensee currently does not have liability insurance for the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809D page. Additionally, civil penalties will be assessed on today's visit for failure to correct. A deficiency was cited on the previous visit, conducted on February 3, 2026, which has not been corrected. An exit interview was conducted with Administrator Eleazar Cuyson. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Feb 13, 2026

Allegation investigated: Administrator not present at the facility a sufficient number of hours Facility is in financial distress Staff did not complete required training Resident records are incomplete

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and interviewed staff and residents as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegations that administrator not present at the facility a sufficient number of hours, facility is in financial distress, staff did not complete required training and resident records are incomplete, the investigation revealed the following: Two out of two staff, witness and administrator confirm administrator is on-site 2 times per week for 2-3 hours. Administrator is newly designated as the prior administrator left the position in December 2025. Administrator states being designated as administrator at five facilities. Three out of three staff and two out of two witnesses confirm Licensee has been slow to pay salaries with wait periods of up to two months. LPA observed facility has bare minimum food supply of two day perishables and seven day non-perishables. All utilities were operational during investigation. LPA reviewed training records and Staff 1 (S1) and S2 do not have proof of required training in the file. CONTINUED ON LIC 9099C DATED 02/03/2026 Substantiated LPA observed all staff have proof of CPR/ First aid training. LPA reviewed resident records during the investigation. Three out of three resident files do not contain the Functional Capabilities Assessment. LPA reviewed the Medication Administration Record (MAR) for February 2026 and it appeared to be in order. The MAR for January is not available as the facility transitioned from electronic to paper with the transition to a new management company in January 2026. Based on record review and interviews conducted, the allegations are determined to be SUBSTANTIATED, meaning the complaint allegations are valid and that a violation has occurred. Based on above findings deficiencies are being cited per California Code of Regulations Title 22 Division 6 chapter 8. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 22-AS-20260126160621

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 4, 2026

The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; This req is not met as evidenced by: Based on interviews conducted, the Licensee did not comply with the section cited above as Licensee does not have sufficient resources to meet operating costs, which poses an immediate health, safety, and personal rights risk to persons in care. CIVIL PENALTY ASSESSEDthe state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee will submit a written plan of action to LPA via email by POC date, that ensures Licensee will have sufficient resources to meet the operating costs of the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Feb 4, 2026

All facilities shall have a qualified and currently certified administrator... The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours... This req is not met as evidenced by: Based on interviews conducted, Licensee did not ensure administrator is on site a sufficient amount of hours. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee to submit a plan of action on how to provide oversight along with an accurate schedule and forward proof to LPA by poc due date. *This is an amended report

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b)(17)(B) · Plan of correction due date: Feb 10, 2026

Each resident’s record shall contain at least the following information: Documents and information required by the following: (B)Section 87459, Functional Capabilities; This req is not met as evidenced by: Based on record review, Licensee failed to ensure a Functional Capabilities Assessment was completed for three out of three residents which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee to complete a Functional Capabilities Assessment for all three residents and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Feb 17, 2026

Licensees shall maintain in the personnel records verification of required staff training and orientation. This req is not met as evidenced by: Based on record review, Licensee failed to ensure staff have required training in the file. Staff 1 and 2 do not have required training which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee to conduct training and forward proof to LPA by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to the facility. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and observed the following: There are three residents and one staff present during today's visit. LPA observed the food supply. Facility has bare minimum of two day perishables and seven day non-perishables. LPA observed food in an auxiliary freezer. Staff stated food gets delivered one time per week. LPA observed an ample emergency food and water supply. Utilities are all in working order as well as kitchen appliances. Sharps and medications are secured. Resident rooms are clear of clutter and lights/ TV's are operational. Restrooms are in order and appear clean and sanitary. LPA observed ample hygiene supply as well as linens. Fire extinguishers are fully charged. Smoke detector/ carbon monoxide detectors are operational during today's visit. 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 removed files for Residents #1-3 for copy and will return the files by close of business today, February 3, 2026. Based on the observations made during today’s visit, NO deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 3, 2026

Type of visit: Case Management - Health Checks

On January 8, 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. Licensee Allen Medina was notified via telephone but was unable 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 caregiver staff, conducted a tour of the physical plant. LPA inspected the five 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 the lights in each of the resident bedrooms 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 111.2 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 in the kitchen pantry. 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 one resident during the visit. During two staff interviews, staff informed LPA that they were supposed to receive their paycheck yesterday, January 7, 2026, for the hours they worked from December 16, through December 31, 2025. However, staff informed LPA that they have not been paid and that they do not know when they will be paid. CONTINUED ON LIC809-C LPA was also informed that the listed Administrator for the facility ended her employment with the company on December 12, 2025. LPA was advised that the facility has a new facility Administrator, however, that Administrator is also overseeing three other facilities within the company. LPA reviewed three staff files. LPA observed that Staff #2 (S2) and Staff #3 (S3) were not background associated to the facility at time of visit. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-Ds. An exit interview was conducted with Administrator Eleazar Cuyson. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Jan 9, 2026

87405 Administrator - Qualifications and Duties: (a) All facilities shall have a qualified... and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility... This requirement is not evidenced by: Based on interviews conducted, the Licensee did not ensure the Administrator is at the facility a sufficient number of hours as they are currently overseeing three other homes. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: The Administrator stated that he will create a plan to ensure the facility has adequate supervisor. The Administrator stated that he will provide LPA the plan via email or fax by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87213 · Plan of correction due date: Jan 16, 2026

87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, .. and that assures sufficient resources to meet operating costs for care of residents.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not have an adequate financial plan in place to ensure staff are paid on schedule. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: The Administrator stated that they will create a financial plan to ensure that staff receive their pay for previous pay period, and for pay periods moving forward. The Administrator agreed to provide LPA the finacial plan via email or fax by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(e)(3) · Plan of correction due date: Jan 16, 2026

87355 Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement was not evidenced by: Based on records reviewed, the Licensee did not ensure that Staff #2 and Staff #3 were background associated to the facility prior to startig their employment. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: The Administrator stated that they will associate Staff #2 and Staff #3 to the facility. LPA will review Guardian on POC date to ensure staff are associated to the facility.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced case management visit to the facility for the purpose of a health and safety check. During the visit, staff on duty contacted facility administrator (AD) Bhonalyn Ladia about visit. For this visit, there are two staff members on duty, of who were background cleared and associated, and LPA Rodriguez met with AD Ladia. For this visit, there are a total of 4 residents in care, of which 0 are on hospice and 0 bedridden. LPA Rodriguez reviewed and observed the following: Payroll records (August 2025-October 2025) - LPA Rodriguez obtained copies of payroll for staff. Food supply (August 2025-October 2025) - LPA Rodriguez observed that facility has 2-day perishable, 7-day non-perishable, and emergency food supply items. LPA verified that groceries are completed once a week. LPA Rodriguez obtained copies of grocery receipts. Utilities (August 2025-October 2025) - LPA Rodriguez conducted a tour of the facility and verified that utilities (gas, water, electricity) are operational. LPA tested water temperatures, of which were measured to be at 118.4 degrees Fahrenheit. Rent (August 2025-October 2025) - LPA Rodriguez obtained copies of rent payments. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued. No health and safety concerns noted. An exit interview was conducted with AD Ladia. A copy of this report was explained and provided.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: POC

On this day, Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 10/14/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. LPA Mendivil observed the following: Deficiency cited under Title 22 Regulation Health & Safety Code 1569.605 pertaining to the facility retaining liability insurance. Licensee has complied with POC, LPA Mendivil called insurance broker to verify, broker stated policy is effective 10/14/2025 to 10/14/2026. LPA Mendivil spoke with Co-Founder/COO Maricel Nepomuceno and advised a copy of liability insurance is due by COB 10/23/2025, COO stated she understood. Deficiency cited under Title 22 California Code of Regulations 87213 pertaining to facility is not financially stable. Licensee has NOT complied with the POC as LPA did not receive a copy of 60 day eviction notices for residents. CIVIL PENALTY ASSESSED. LPA Mendivil toured and inspected the facility and observed no health and safety issues. The facility was in good repair. Property utilities were working, such as electricity, gas and water. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA conducted health and safety checks on residents and observed no health or safety concerns. An exit interview was conducted and a copy of this report, LIC 421FC and appeal rights were provided to Administrator.the state’s words, verbatim · CDSS document, Oct 23, 2025

Allegation investigated: Facility is financially unstable Facility does not have liability insurance

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into a facility and explained the reason for the visit. The Department received a complaint on 10/06/2025. Regarding the allegations facility is financially unstable and the faciltiy does not have liabiltiy insurance, the investigation revealed the following: It was alleged the faciltiy is financially unstable, per interviews with Licensees Allen Medina and Maricel Nepomuceno the rent for the faciltiy is due on the 1st and as of today 10/14/2025 the facilty has not paid the landlord for the rent. Per Allen the facility received a 3 day notice to pay or quit on 10/11/2025. Licensee Allen stated they do not have liability insurance. Substantiated Therefore based on interviews the allegations that facility is financially unstable and the facility does not have liability insurance are determined to be SUBSTANTIATED, meaning the complaint allegation as valid and that a violation has occurred. Based on above findings deficiencies are being cited per California Code of Regulations Title 22 Division 6 chapter 8. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 14, 2025 · control 22-AS-20251006160010

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Oct 15, 2025

The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on Licensee interview, the Licensee did not comply with the section cited above as Licensee does not have sufficient resources to meet opeating costs for care of the residents, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 14, 2025

Plan of correction: Licensee stated will issue 60 day eviction notices to residents and will provide copies to LPA Mendivil by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Oct 15, 2025

all residential care facilities for the elderly … shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee. This requirement was not met as evidence by Licensee stated they do not have liability insurance. This poses an immediate health and safety risk to person in care.the state’s words, verbatim · CDSS document, Oct 14, 2025

Plan of correction: Licensee stated will obtain liability insurance and provide proof to LPA by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a health and safety check of the residents at the facility. LPA was greeted and granted entry by staff. LPA met with Administrator Bhonalyn Ladia and explained the reason for the visit. LPA and Administrator toured the facility. LPA observed all resident rooms had the required furnishings. LPA observed all resident rooms are clean and organized. LPA observed all resident bathrooms (3) are clean and operational. Hot water measured 110.0 degrees Fahrenheit. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen, Medications are kept locked in a kitchen cabinet. Knives and sharp objects are kept locked in a kitchen drawer. The fire extinguishers in the hallways are fully charged. LPA observed a 3 day emergency supply of food and water stored in living room closet. The garage is kept locked and used for storage. There are extra supplies and food stored in the garage. LPA observed the first aid kit did not have a first aid manual. Smoke detectors/carbon monoxide detectors tested operational. LPA and Administrator toured the backyard. No bodies of water observed. There is a shaded seating area for residents to sit outside. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA consulted with the Administrator concerning reporting requirements. All staff present (3), Administrator and 2 caregivers, are background cleared and associated to the facility. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jun 23, 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: o Licensee's responsibilities of facility oversight o Licensee's requirement to maintain control of facility and property o Licensee’s responsibility to maintain financially solvent o Licensee’s responsibility to communicate with the Department o Report of suspected dissolution of partnership The following was agreed upon during today's meeting: · Licensees has clarified the dissolution of partnership is not related to license but rather a separate business deal. The dissolution of partnership will not impact Licensees facilities. · The Licensees has reported they are in communication with landlords for property’s leased and will maintain a valid lease and control of property. · The Licensees will maintain payment of all facility bills and ensure sufficient staffing to meet resident’s needs. The Licensee will communicate any health and safety concerns related to the 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. · Current lease agreements with letters from landlords voiding any outstanding evictions or unlaw 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

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Administrator (AD) Bhonalyn Ladia and explained the purpose of the inspection. LPA and AD conducted a tour of the facility. LPA observed the facility has electricity, gas, water, internet and phone service. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable food. Medication was observed to be centrally stored and locked in a kitchen cabinet. Sharps were observed to be locked in a kitchen drawer. Interviews were conducted with two staff and Licensee Allen Medina. During their interview, two of two staff denied any knowledge of the facility’s financial status and stated the utilities have been and continue to be operational and food supply is maintained as observed during today’s visit. (Cont. LIC9099-C) Substantiated During their interview, Licensee stated that although all financial costs for operating the facility are current, they are not always paid timely. Per Licensee, funds need to be allocated prior to financial costs being covered, and the rental payment for the facility is often late. Per Licensee, if a resident is late or does not pay their monthly rent, they are unable to cover the cost of operating the facility. Licensee stated that currently a significant amount of their funds is going to legal fees. No health or safety concerns were observed during today's visit. Based Licensee interview, the preponderance of evidence standard has been met; therefore the above allegation is found to be substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of regulations. (See LIC9099-D). An exit interview was conducted. A copy of this report, and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, May 14, 2025 · control 22-AS-20250508112501

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: May 15, 2025

The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on Licensee interview, the Licensee did not comply with the section cited above as Licensee does not have sufficient resources to meet opeating costs for care of the residents, which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 14, 2025

Plan of correction: Licensee stated they will submit a written plan of action to LPA via email by POC date, that ensures Licensee will have sufficient resources to meet the operating costs for care of the residents.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Brandon Lopez and Licensing Program Manager (LPM) Sheila Santos made an announced visit to the facility for the purpose of conducting a Pre-licensing Inspection. LPA and LPM met with Applicants Team Brian Mahinay, Bhonalyn Ladia, Rosendo Carlo Mirando, Justin Duclayan, Christopher Cerame, and Johanna Gomez. The current Administrator for the facility is Rosendo Carlo Mirando. The facility will notify Community Care Licensing once Bhonalyn Ladia receives her Administrator certificate. LPA observed that Administrator Rosendo Carlo Mirando has a valid Administrator certificate which expires on April 8, 2026. All individuals present during the visit are background cleared and associated. An initial application to operate a Residential Care Facility for the Elderly (RCFE) for a capacity of six non-ambulatory residents was received by Community Care Licensing (CCL) on December 11, 2024.This is a change of ownership with six residents already in care. The facility received an approved Fire Clearance by Orange County Fire Authority Inspector Shannon Chan on June 12, 2024. The facility is a one-story home with five resident bedrooms, one staff room, two shared resident bathrooms, a kitchen, a dining room, a living room, a courtyard, and an attached two car garage. LPA and LPM accompanied by the Applicants Team, conducted a tour of the physical plant. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the entryway of the facility. LPA inspected the five resident bedrooms. The five resident bedrooms are clean and free of hazards. LPA observed all the resident bedrooms has the required furnishings of a bed, a chair, and chest of drawers, and a lamp. Resident beds have clean linens and blankets. LPA observed additional linens stored in a hallway closet. Resident bathrooms are clean. Bathrooms were equipped with grab bars and non-slip mats. Faucets and toilets were operational. Hot water temperature measured between 107.2 and 113.5 degrees Fahrenheit. LPA observed the facility has an emergency food and water supply and personal protective equipment stored in a hallway closet. CONTINUED ON LIC809-C LPA observed the facility has reading books and puzzles for resident use stored in the dining room. The facility has an internet device for resident use in the dining room. Resident and staff records are kept locked in a storage dresser in the dining room. LPA observed the kitchen has a minimum two-day perishable and seven-day non-perishable food supply on hand. LPA observed the the electric stove, the refrigerator, the microwave, and the dishwasher to be clean and operational. LPA observed knives to be locked inside a kitchen cabinet. Fire extinguishers are located in the resident hallway and the garage. Fire extinguishers were observed to be charged and serviced as of April 11, 2024. LPA tested the wired smoke/carbon monoxide detectors which tested operational. Auditory devices tested operational for all exits. The centrally stored medication is located inside a kitchen cabinet. LPA observed the First Aid Kit had all the required components. The door leading to the attached two car garage is inaccessible to residents and is used for storage and for laundry. Cleaning supplies are located in the garage and will continue to be stored here. LPA and LPM accompanied by the Applicants Team toured the outside of the facility and observed it to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the exterior of the facility is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Component III was completed with the Applicants Team which provided information about how to operate the facility within compliance and reporting requirements. The Applicant Team were notified that the final application approval will be issued by the Centralized Applications Bureau (CAB) in Sacramento. An exit interview was conducted, and a copy of this report was provided to the Applicants Team.the state’s words, verbatim · CDSS document, Jan 15, 2025