The Hills of Sierra Majorca

Type of visit: Case Management - Health Checks

On September 1, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Licensee (LI) Allen Medina was notified of the visit but was unable to assist with today's inspection. On today's visit, there were two residents in care and there was one care giving staff present. LPA, accompanied by the 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's bedroom to be operational. LPA inspected the three shared resident bathrooms located in the facility and observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 105.6 and 105.9 degrees Fahrenheit. LPA inspected the facility's kitchen area and observed it to be clean. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed the facility has a three day emergency food and water supply stored in the pantry. LPA, accompanied by the staff, conducted a tour of the exterior portions of the facility. LPA observed the exterior to be free of any hazards or obstructions. 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 the two residents and one staff of the facility during the visit. LPA also conducted an interview with the landlord of the property, Witness #1 (W1), during the visit. W1 advised LPA that the facility still has not paid the last three months rent and still owe approximately $22,500.00. CONTINUED ON LIC809-C W1 also provided LPA a copy of the unlawful detainer that was filed against the Licensee on July 27, 2026, as a result of their missed rent payments. According to California Code of Regulation Section 87211(d)(2), it states: "(d) The licensee shall notify the Department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their representatives, in writing within two business days of any of the following specified events, or knowledge thereof: (2) An unlawful detainer action is initiated against the licensee. However, Community Care Licensing was not informed by the Licensee regarding the unlawful detainer. LPA also conducted an interview with the Responsibly Party for Resident #1 (R1), Witness #2 (W2). W2 advised LPA that they were not aware of the unlawful detainer and confirmed that the Licensee of the facility did not inform them of it. W2 also advised LPA that they were unaware of the proceedings initiated against the Licensee by Community Care Licensing. W2 stated that the Licensee of the facility did not provide them with a written notice of the commencing of the proceedings. Additionally, during the visit, LPA observed that the facility did not have a copy of the notice regarding their legal proceedings, despite them being previously advised to post it. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. The Licensee will be issued a civil penalty in the amount of $250.00 for a repeat violation. The Licensee was previously issued a citation under California Code of Regulation, Title 22, Section 87213, on August 12, 2026. The Licensee will be issued a second civil penalty in the amount of $250.00 for a repeat violation. The Licensee was previously issued a citation under Health and Safety Code 1569.38(b)(1) on July 7, 2026. The Licensee will be issued a third civil penalty in the amount of $250.00 for a repeat violation. The Licensee was previously issued a citation under Health and Safety Code 1569.38(e) on August 12, 2026. LPA called Licensee Allen Medina via telephone to conduct an exit interview, however, Licensee Allen Medina did not answer. A copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, Sep 1, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Sep 2, 2026

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observations & records reviewed, the Licensee does not have a sufficient financial plan as the facility has an overdue balance of $22,500 in past due rent and have an unlawful detainer filed against them. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 1, 2026

Plan of correction: The Licensee will provide LPA a written financial plan on how they will address the facility's outstanding rent balance and the unlawful detainer. The Licensee will provide LPA the written plan via email or fax by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.38(b)(1) · Plan of correction due date: Sep 2, 2026

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

Plan of correction: The Licensee will provide the written notices to the two residents, and their responsible parties, of the facility regarding the proceedings. The Licensee will provide LPA proof of the written notice via email or fax by POC due date. LPA to follow up with residents and their responsible parties.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(d)(2) · Plan of correction due date: Sep 2, 2026

87211 Reporting Requirements: (d) The licensee shall notify the Department,.., all residents,..., their representatives, in writing within two business days of any of the following specified events, or knowledge thereof: (2) An unlawful detainer action is initiated against the licensee. This requirement is not evidenced by: Based on records & interviews, the Licensee did not notify the Department, residents, or their representatives regarding the unlawful detainer filed against them. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 1, 2026

Plan of correction: The Licensee will provide a written notice to Community Care Licensing, the residents, and their representatives regarding the unlawful detainer. The Licensee will provide proof of the written notices being sent to LPA via email or fax by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.38(e) · Plan of correction due date: Sep 2, 2026

§1569.38 Posting of licensing reports; disclosure to new residents: (e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice.. in the facility.. This requirement is not evidenced by: Based on observation, the Licensee did not ensure that a notice regarding the proceedings from Community Care Licensing was posted at the facility during today's visit. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 1, 2026

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

Type of visit: Case Management - Health Checks

On August 12, 2026, at 12 PM, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee (LI) Maricel Nepomuceno was notified via telephone but was unable to assist with the inspection. On today's visit, the facility has a census of three residents, however, there were only two resident physically present during the visit. LPA also observed two care giving staff present. 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's bedroom to be operational. LPA inspected the three shared resident bathrooms located in the facility and observed bathrooms to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. LPA attempted to test the hot water temperature and observed that the facility did not have any water. Per the facility staff present, the water was shut off upon LPA's arrival to the facility at approximately 12 PM. LPA inspected the kitchen area and 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 kitchen pantry. LPA observed the remaining utilities, such as the electricity, gas, and internet, to be operational during the visit. LPA conducted a tour of the exterior portions of the facility and observed it to be free of any hazards. CONTINUED ON LIC809-C LPA additionally conducted interviews with two staff and the residents present during the visit. LPA then made telephone calls to Licensees Allen Medina and Maricel Nepomuceno to make them aware of the water being shut off at the facility. Licensee Maricel Nepomuceno confirmed that the water had been shut off due to the facility having an outstanding balance in their water bill. LPA requested and reviewed the facility's water bill for July 2026, and observed that the facility had an overdue balance in the amount of $1,337.33. The Licensees were able to restore the facility water at approximately 3 PM, meaning the facility did not have water for approximately two hours. During the visit, LPA also made a telephone call to the landlord of the property, Witness #1 (W1). W1 said that the facility has not paid their monthly rent for the last three months. W1 said that the facility currently owes approximately $22,500.00 in past due rent. W1 said that they are also pursuing an eviction as a result of unpaid rent. On May 8, 2026, the Department notified the Licensees that they have began proceedings to revoke the license of the facility. Per Health and Safety Code Section 1569.38(e): "(e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility, that may include where the mail boxes are located, where the facility license is posted, or any other easily accessible location in the facility. The posting shall include all of the following information:" On today's visit, over ninety days after the Licensees were notified of the proceedings, LPA observed that the facility did not have a copy of the notice posted in the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. A civil penalty will also be assessed in the amount of $250.00 for a repeat violation. The Licensees were previously issued a citation under California Code of Regulation, Title 22, Section 87213, on March 26, 2026. An exit interview was conducted with Licensee Maricel Nepomuceno via telephone. A copy of the report and appeal rights were provided to the facility at time of visit.the state’s words, verbatim · CDSS document, Aug 12, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Aug 13, 2026

87303 Maintenance and Operation: (e) Water supplies ..shall be maintained as follows: (2) Faucets .. shall deliver hot water. Hot water .. shall be maintained .. not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement was not evidenced by: Based on observation, the Licensee did not ensure the facility had water as the facility was experiencing a water shutoff upon LPA's arrival to the facility. The facility remained without water for approximately two hours. This poses and immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 12, 2026

Plan of correction: The Licensee was able to restore the facility's water after approximately two hours by paying the past due balance. POC cleared at time of visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Aug 13, 2026

87213 Finances: The licensee shall have a financial plan.. shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency... This requirement was not evidenced by: Based on observations & records reviewed, the Licensee does not have a sufficient financial plan as the facility has an overdue balance of $22,500 in past due rent and of $1,337.33 in their water bill. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 12, 2026

Plan of correction: The Licensee stated that they will provide LPA a written financial plan on how they will address the facility's outstanding rent balance and ensure utilities are operational. The Licensee agreed to provide LPA the written plan via email or fax by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(e) · Plan of correction due date: Aug 13, 2026

§1569.38 Posting of licensing reports; disclosure to new residents: (e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice.. in the facility.. This requirement is not evidenced by: Based on observation, the Licensee did not ensure that a notice regarding the proceedings from Community Care Licensing was posted at the facility during today's visit. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 12, 2026

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

Type of visit: Case Management - Health Checks

On July 7, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Karla Miranda was notified via telephone, but was unable to assist with the inspection. Karla provided verbal agreement that caregiver Valeria can sign on her behalf. On today's visit, LPA observed that facility currently has a census of three residents. LPA observed residents watching television, and sleeping. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the three bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 109.4 to 109.5 degrees Fahrenheit. Fire extinguishers were tagged on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with two staff and two residents. LPA was informed that the facility currently has sufficient groceries at this time. LPA observed that the annual fees have been paid. Based on this inspection, there are deficiencies cited at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with authorized representative and a copy of this LIC809 report was reviewed and provided at the facility. Appeal Rights were reviewed.the state’s words, verbatim · CDSS document, Jul 7, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b)(1) · Plan of correction due date: Jul 8, 2026

§1569.38 (e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility, that may include where the mail boxes are located, where the facility license.. (cont.) is posted, or any other easily accessible location in the facility. Based on observation, the Licensee did not ensure a notice regarding the proceedings was posted at the facility.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: Licensee was informed by LPA that a copy of the Accusation was provided to the facility and staff has to be posted in a prominent location by the front door. Licensee stated they will post it no later than 07/08/2026 and send proof of correction to CCLD by POC due date.

Type of visit: Case Management - Health Checks

On May 22, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management 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, but was unable to assist with the inspection. On today's visit, LPA observed that facility currently has a census of six residents. LPA observed residents watching television, and sleeping. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the three bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 105.4 and 112.6 degrees Fahrenheit. Fire extinguishers were tagged on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with two staff and two residents. Two out of two staff interviewed stated that they were paid in full on May 11 and May 14, 2026. Both staff are expected to be paid today, May 22, 2026. LPA will follow up on the next visit. LPA observed that the annual fees have been paid. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with authorized representative and a copy of this LIC809 report was reviewed and provided at the facility.the state’s words, verbatim · CDSS document, May 22, 2026

Type of visit: Case Management - Health Checks

On May 5, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management 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 provided verbal consent that Pauline Serduar can sign on his behalf. On today's visit, LPA observed that facility currently has a census of six residents. LPA observed residents watching television, sitting outside, and sleeping in the living room. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the three bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 105.9 and 106.7 degrees Fahrenheit. Fire extinguishers were tagged on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with three staff and three residents. Three out of three staff interviewed stated that they were paid in full on May 1, 2026 and they are not owed any outstanding balances. LPA observed that the annual fees have been paid. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with authorized representative and a copy of this LIC809 report was provided and left at facility.the state’s words, verbatim · CDSS document, May 5, 2026

Type of visit: Case Management - Health Checks

On April 20, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management 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 visit. On today's visit, LPA observed that facility currently has a census of six residents. LPA observed residents watching television and sleeping in the living room. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the three bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 112.6 and 113.0 degrees Fahrenheit. Fire extinguishers were tagged on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with three staff and three residents. Three out of three staff interviewed stated that they were paid in full on April 10, and 17, 2026 and they are not owed any outstanding balances. Staff reported that they will be paid on April 24, 2026. LPA observed that the annual fees have been paid. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of this LIC809 report was provided and left at facility.the state’s words, verbatim · CDSS document, Apr 21, 2026

Type of visit: Case Management - Health Checks

On April 10, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management 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 provided verbal consent that Mhike Escario can sign on his behalf. On today's visit, LPA observed that facility currently has a census of six residents. LPA observed residents watching television and sleeping in the living room. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the three bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 105.3 and 115.3 degrees Fahrenheit. Fire extinguishers were tagged on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with three staff and two residents. Three out of three staff interviewed stated that they were paid in full on April 3, 2026 and they are not owed any outstanding balances. Staff reported that they are supposed to be paid today via checks and the administrator will drop off the checks later this afternoon. LPA observed that the annual fees have been paid. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with authorized representative and a copy of this LIC809 report was provided and left at facility.the state’s words, verbatim · CDSS document, Apr 10, 2026

Type of visit: Case Management - Health Checks

On April 3, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management 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 provided verbal consent that Rowena Manalo can sign on his behalf. On today's visit, LPA observed that facility currently has a census of five residents. LPA observed residents watching television in the living room and sleeping in their rooms. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the three bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 105.6 and 114.0 degrees Fahrenheit. Fire extinguishers were tagged on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with three staff and two residents. Three out of three staff interviewed stated that they were paid in full on April 3, 2026 and they are not owed any outstanding balance. LPA observed that there remains an outstanding annual fee in the amount of $742.00. LPA reminded Licensee that the amount was due in February 14, 2026, and advised them to make a payment as soon as possible to avoid late fees. Licensee stated the payment will be made no later than today. Based on this inspection, no deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 of the California Code of Regulations. However, a civil penalty was assessed on today's visit for failure to correct and repeat violation at the amount of $250. This report was reviewed with authorized representative and a copy of this LIC809 and LIC421FC report was provided and left at facility. Appeal Rights were reviewed, and a copy provided at the facility.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Case Management - Health Checks

On March 26, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management 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 provided verbal consent that Rowena Manalo can sign on his behalf. On today's visit, LPA observed that facility currently has a census of five residents. LPA observed residents watching television in the living room. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 106.5 and 115.5 degrees Fahrenheit. Fire extinguishers were tagged on March 23, 2026. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with three staff and two residents. Two out of three staff interviewed stated that they received a late partial payment on March 26, 2026. Both staff stated that they were supposed to be paid on March 22, 2026. LPA observed that there remains an outstanding annual fee in the amount of $742.00. LPA reminded staff that the amount was due in February 14, 2026, and advised them to inform management to make a payment as soon as possible to avoid late fees. 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. Additionally, civil penalties will be assessed on today's visit for failure to correct and repeat violation at the amount of $600. This report was reviewed with authorized representative and a copy of this LIC809, LIC809-D, and LIC421FC report was provided and left at facility. Appeal Rights were reviewed, and a copy provided at the facility.the state’s words, verbatim · CDSS document, Mar 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 27, 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 time and in full. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay on time. The financial plan shall be submitted 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 31, 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 2026. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 26, 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

On March 20, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to conduct a Case Management - Health Checks inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone and provided verbal consent that caregiver can sign on his behalf. On today's visit, LPA observed that facility currently has a census of five residents. LPA observed residents watching television in the living room. LPA, accompanied by staff, conducted a tour of the physical plant of the facility. LPA inspected the five resident bedrooms (one shared bedroom and four private bedrooms), living room, kitchen, dining room, and an attached two car garage. LPA observed them to be free of hazards. The garage is used for storage and laundry. LPA observed residents bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed the lights in each of the resident's bedroom to be operational. LPA inspected the two bathrooms located in the facility. LPA observed bathrooms to be clean and operational. Bathrooms were equipped with grab bars and non-skid floor mats. Hot water temperature measured between 105.9 and 113.3 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply located in the pantry. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner convection stove to be operational. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed all of the facility's utilities, such as the electricity, water, gas, and internet, to be operational during the visit. Continued on LIC 809-C LPA additionally conducted interviews with two staff and two residents. One out of the two staff interviewed stated that they were paid on March 13, 2026, and they are not owed a remaining balance on their paychecks. One out of two staff reported they were not paid on March 13, 2026 and was only paid a partial amount on February 22, 2026. LPA observed that there remains an outstanding annual fee in the amount of $742.00. LPA reminded staff that the amount was due in February 14, 2026, and advised them to inform management to make a payment as soon as possible. Financial records have been received as of March 6, 2026. 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. Additionally, civil penalties will be assessed on today's visit for failure to correct and repeat violation at the amount of $500. This report was reviewed with authorized representative and a copy of this LIC809, LIC809-D, and LIC421FC report was provided and left at facility. Appeal Rights were reviewed, and a copy provided at the facility.the state’s words, verbatim · CDSS document, Mar 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 21, 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 time. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2026

Plan of correction: The Administrator/Licensee to submit a financial plan to ensure that staff receive their pay on time. The financial plan shall be submitted 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 31, 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 2026. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 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

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 five 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 three shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. The water in each of the resident bathroom was operational and measured between 109 to 119.7 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and five residents during the visit. Three out of the three staff interviewed reported that they were supposed to be paid on February 13, 2026, for the hours they worked from January 21, to February 3, 2026. CONTINUED ON LIC809-C However, the three staff stated that they have only received partial pay as of today, therefore, the Licensees are eleven days behind on the scheduled pay date. Additionally, two staff stated that they received a pay check on February 19, 2026, for this past pay period. However, they were informed by their banks that this payroll check will not clear until March 3, 2026. Three out of three staff interviewed also stated that they have been paid late in previous pay periods. One out of the three staff stated that they are owed back pay from previous pay periods. 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. 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

On February 19, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced case management visit for a Health & Safety check. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone and provided verbal approval that caregiver Rowena Manalo can sign the report on his behalf. On today's visit, LPA observed five residents in care and two staff present. LPA observed residents watching television in the living room, eating breakfast in the dining room, and resting in their bedrooms. LPA observed residents to be in clean clothes. LPA, accompanied by the caregiver, conducted a tour of the physical plant. LPA inspected the four private resident bedrooms and one shared bedroom, and observed them to be free of hazards. LPA observed residents' bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed the lights in each of the resident bedrooms to be operational. The water and toilets in each of the resident bathrooms were operational. The hot water temperature measured between 109.4 to 114 degrees Fahrenheit. LPA observed the facility has two day perishable and seven day nonperishable food supplies on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner electric stove to be operational. LPA observed the facility has three day emergency food and water supplies stored in the garage. No health or safety concerns were observed. LPA additionally conducted interviews with two staff and two residents. Per staff interview, there were no issues with food supplies or utilities. However, two out of Continued on LIC 809-C. two staff reported late payments. Two out of two staff were supposed to be paid on February 13, 2026 and as of today, no payments have been made. The facility currently has unpaid annual fees in the amount of $459.00. Liability insurance was provided and reviewed. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of California Code of Regulations. An exit interview was conducted with Administrator Eleazar Cuyson via telephone and a copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 19, 2026

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 shared resident bathrooms, 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 five 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 closet. LPA observed the staff bedroom is kept locked and inaccessible to residents in care. LPA inspected the three 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 108.5 to 114 degrees Fahrenheit. LPA observed the facility has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C 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 15, 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 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 observed the facility has a three day emergency food and water supply stored in the garage. 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 five residents files. LPA observed the facility did not have proof of a TB test on file for Resident #2 (R2). LPA reviewed the residents' medication and medication administration record. LPA reviewed four staff files. LPA observed that Staff #4 (S4) did not have a Health Screening or proof of a TB test on file. LPA observed that Staff #2 (S2) and Staff #3 (S3) also did not have proof of a TB test on file. All staff are background cleared and associated to the facility. LPA observed the Licensee currently does not have liability insurance for the facility. The Administrator was also reminded that the facility owes its annual fees. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809D pages. Additionally, civil penalties will be assessed on today's visit for a repeated violation. 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

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to the facility for the purpose of a health and safety check. 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 five residents and two staff present during today's visit. LPA observed the food supply. Facility has minimum of two day perishables and seven day non-perishables. LPA observed food in an auxiliary freezer/ refrigerator. 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 #1-5 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 five 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 three 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 105.8 and 114.4 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the facility has a three day emergency food and water supply stored in the attached two car garage. No health or safety concerns were observed during the visit. LPA observed all of the facilities utilities to be operational during the visit. LPA additionally conducted interviews with three staff and four residents during the visit. All three 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 the five resident files. LPA observed that there was no Medical Assessment on file for Resident #3. LPA also observed there were no valid Admission Agreements on file for Resident #4 and Resident #5. 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 was 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 87458(a) · Plan of correction due date: Jan 30, 2026

87458 Medical Assessment: (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional ...to be kept in the resident's record. This requirement was not evidenced by: Based on a review of resident records, the Licensee did not ensure that there was a Medical Assessment on file for Resident #3 prior to their admission to the facility. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: The Administrator stated that they will obtain a Medical Assessment for Resident #3 (R3). The Administrator agreed to provide the Medical Assessment for R3 to LPA via email or fax by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87507(a) · Plan of correction due date: Jan 30, 2026

87507 Admission Agreements: (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement was not evidenced by: Based on a review of resident records, the Licensee did not ensure there were valid Admission Agreement on file for Resident #4 and Resident #5. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: The Administrator stated that they will complete valid Admission Agreemeents for Resident #4 (R4) and Resident #5 (R5). The Administrator agreed to provide the Admission Agrements for R4 and R5 to LPA via email or fax by POC date.

Allegation investigated: Facility staff did not refund resident's authorized person upon resident's death

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 the facility by staff and explained the reason for the visit. The Department received a complaint on 12/01/2025 and the initial 10 day visit was conducted on 12/04/2025. LPA Mendivil obtained copies of admission agreement for Resident 1 (R1) Regarding the allegation facility staff did not refund resident's authorized person upon resident's death, the investigation revealed the following: It was reported that R1 had passed away on 09/03/2025, per admission agreement signed on 05/05/2025 on page 5 the refund policy is listed which states "the first 14 days upon moving into the community are non-refundable, anything after 14 days is refundable and will be based on a prorated amount" Substantiated Per interview with Owner/Licensee Allen Medina it was stated a refund was never issued to R1's family following their death and termination of admission agreement. Therefore based on preponderance of evidence through interviews and records reviewed the allegation Facility staff did not refund resident's authorized person upon resident's death is 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, Dec 4, 2025 · control 22-AS-20251201234600

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Dec 10, 2025

(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual...responsible for the fees... within 15 days after the personal property is removed. This requirement was not met as R1's authorized representatives did not receive a refund. This poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 4, 2025

Plan of correction: Licensee stated will issue check via certified mail and provide proof to LPA by POC due date.

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 5 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 116.2 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 10/12/2025, Licensee stated is trying to get payment, but does not have a date to pay. 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-20251006160520

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. an immediate civil penalty is assessed due to repeat violation.

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 explained the reason for the visit. Administrator Bhonalyn Ladia arrived during the visit. LPA and staff 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 110.3 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 extinguisher in the hallway is fully charged. LPA observed a 3 day emergency supply of food and water in the garage. The garage is kept locked and used for storage. 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. There is no exit gate in the backyard. The backyard connects to the front porch with a walkway. No obstacles or hazards observed in the backyard. LPA consulted with the Administrator concerning reporting requirements. 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-20250508111720

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) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Administrator Bhonalyn Ladia and the management team. An initial application to operate a Residential Care Facility for the Elderly was submitted to Community Care Licensing on 12/10/2024 for a capacity of six non-ambulatory residents. Upon entry, facility appears clean and sanitary. Facility has all required postings at entrance. Administrator Bhonalyn Ladia has an administrator certificate expiring on 01/29/2027. This pre-licensing is a change of ownership with six residents present during today's visit. LPA Lyman along with Administrator Ladia and Director of Operations Joanna Gomez toured the facility at 1:08 PM and observed the following: Structure: Facility is a one story, 6 bedroom, 3 bathroom home with living room, dining room, kitchen and den. There is an attached garage and a tan exterior. One bedroom is reserved for staff. LPA observed night lights in hallway of facility. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: Rooms will be single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Auditory exit alarms are operational. Linens & Hygiene Supplies: Facility has ample bedding and towels in supply. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Emergency Phone Numbers and Exit Plan: Posted in the entrance of the facility. Food Service: Facility has 2 day perishables as well as 7 day non-perishables. Smoke Detectors: Smoke detectors/ carbon monoxide detectors are centrally wired and were tested operational. Fire extinguishers are fully charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins/ Sharps: Facility has multiple secured areas for toxins and sharps. Water Temperature: Tested and recorded between 110.6 and 118.2 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food and water as well as a posted emergency disaster plan. Facility has additional emergency supplies present including flashlights. Licensee has multiple generators stored off-site for emergency use. CONT ON LIC 809C DATED 02/06/2025 Medications, First-Aid Kit & Book: First aid kit observed contained all required items including tweezer, scissors and thermometer. LPA observed a first aid manual. Medication is stored in a locked cabinet. Facility uses an electronic medication administration record. Resident & Staff File: Records are stored in a secured cupboard in the kitchen. Reading Material, Games, and Equipment: Facility provides activities such as games, music therapy and exercise. Backyard: LPA observed a clean backyard with ample shaded seating for residents. Fire Clearance: Approved for six non-ambulatory residents on 06/12/2024. During the visit, LPA consulted with the management team regarding bedridden fire clearance and process for requesting the clearance. Component III conducted. Facility is ready to be licensed. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 6, 2025