Tiffany's Board and Care IV

Type of visit: Office

An Informal Office Meeting was held today in the Monterey Park Regional Office. The purpose of this informal conference meeting is to discuss the high number of uncleared citations issued on the previous two (2) annual inspections conducted on 8/21/2025 and 6/30/2026. Present in the meeting was Licensing Program Analyst (LPA) Erik Zaragoza, Licensing Program Manager (LPM) David Sicairos, and administrator for the facility Tiffany Sasada. Items discussed included how the facility has addressed the following: Three (3) Uncleared Type A citations on Annual Conducted on 8/21/2025. Six (6) Type B citations issued during the annual conducted on 8/21/2025. Two (2) Uncleared Type A citations on Annual conducted on 6/30/2026. Eleven (11) uncleared Type B citations issued on 6/30/2026. One (1) cleared Type A violation issued on 6/30/2026. One (1) cleared Type B violation issued on 6/30/2026. Pending Planned Change of Ownership (CHOW) for the facility. Concerns in preventing LPA from accessing Bedroom #1 and the Garage for the facility as defined on the current facility sketch. The facility has stated they will do the following to achieve continued and substantial compliance: Administrator explained that she will submit POCs for all uncleared deficiencies by 8/28/2026. Administrator explained that there are two (2) separate addresses located at the facility, 16955 Janine Dr, Whittier, CA 90603, which is the portion of the licensed property/facility that serves residents, and 16957 Janine Dr, Whittier, CA 90603 which is the residence of the current administrator Tiffany Sasada. Community Care Licensing Division (CCLD) at this time does not have any documentation or proof that these two (2) addresses are separate at this time. Administrator indicated she went to city hall yesterday to obtain documentation that shows 16957 Janine Dr, Whittier, CA 90603 is a separate address, and city hall staff indicated that they would provide documentation showing/proving this by the end of next week. CCLD requested administrator to submit this documentation to LPA as soon as it is received. Administrator stated that moving forward, she will allow CCLD entry to Bedroom #1 and the Garage as indicated on the current facility sketch that CCLD currently has in the facility file. Administrator did not provide any updates on the pending application for the CHOW, because potential applicant Mylyn Castillo is handling the CHOW process with the Centralized Application Bureau (CAB). CCLD discussed with the administrator that an Accessory Dwelling Unit (ADU) or separate address should not prevent the licensure for a Change of Ownership. However administrator and Mylyn Castillo were instructed to contact CAB for further guidance. Failure to correct Plans of Correction (POCs) or failure to pay issued civil penalties could result in administrative action. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies issued following the meeting. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 19, 2026

Type of visit: POC

Liicensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Plan of Correction (POC) visit to follow up on citations that were issued on 6/30/2026 during the facility's Annual Inspection. LPA met with S2 and explained the purpose of the visit. On 6/30/2026, the facility was cited for the following which was due 7/17/2026: Title 22 87470(c): "(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208." Since the citation was issued, LPA has not received the infection control plan. Title 22 87208(a): "(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval." Since the citation was issued, LPA has not received an updated facility sketch which also includes the original bedroom #1 and garage that are listed in the original facility sketch the licensing agency has on file. Title 22 87211(a)(1): "(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case." LPA has not received a death report for the identified resident since the initial visit. Title 22 87303(c): "(c) All window screen shall be clean and maintained in good repair." LPA observed that a window screen has been placed and the deficiency will be cleared. Title 22 87468(c)(2)(A): "(A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website." Since the citation was issued, the PUB 475 poster is still not posted inside the facility. Health and Safety Code 1569.625(b)(1): "(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training." Since the initial visit, LPA has not received any proof of the two (2) identified staff members' training on appropriate topics. Title 22 87457(c): "(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations." Since the visit LPA has still not received the Pre-Admission Appraisal for Resident #2. Title 22 87463(a): "(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal." Since the initial visit, LPA has not received the reappraisal for Resident #1. Health and Safety Code 1569.695(c): "(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill." Since the initial visit, LPA has not received any documented disaster drill from the facility. Title 22 87608(a)(5)(A): "(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed." Since the initial visit, LPA has not received the physician order for Resident #1's half-bed rail. Civil Penalties will be assessed due to failure to adhere to the POC for the identified regulations and health and safety codes on the LIC421FC pages. Exit interview conducted and a copy of this report was emailed to administrator Tiffany Sasada.the state’s words, verbatim · CDSS document, Jul 24, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Plan of Correction (POC) visit to follow up on citations that were issued on 6/30/2026 during the facility's Annual Inspection. LPA met with S2 and explained the purpose of the visit. Administrator Tiffany Sasada was notified of the visit by phone call. On 6/30/2026, the facility was cited for the following: Health and Safety Code 1569.32: Any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, this chapter. LPA has not received proof that Bedroom #1 and the Garage of the facility is a separate address "16957 Janine Dr, Whittier, CA" from the facility address. Administrator stated that she will submit blueprints to LPA by email as proof that the address is separate. Title 22 87355(e)(3) 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). LPA observed that S2 and S3 are still not associated to the facility, but rather a different facility. Administrator along with S2 are working to associate S2 and S3 to facility currently. Title 22 87608(a)(5)(B) Postural Supports: (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. LPA checked R2's bedroom and observed that they still have full rails on their bed. S2 stated that they will provide half rails with a physician order for R2 or submit an exception request for R2 to have full rails as a medical necessity. Civil Penalties will be assess due to failure to adhere to the POC for Health and Safety Code 1569.32 and Title 22 87608(a)(5)(B) Postural Supports. Exit interview conducted and a copy of this report was provided to S2.the state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Mylyn Castillo, caregiver for the facility, and explained the purpose of the visit. Administrator Tiffany Sasado was notified of the visit by phone call. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan was not present in facility. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. The facility consists of four (4) resident bedrooms, a multipurpose room, a kitchen, dining room, a living room, and two (2) resident bathrooms which both fell within the required range of 105 – 120 degrees Fahrenheit. The carbon monoxide detector is operational in the home. A fully charged fire extinguisher is kept on the premises. · LPA was not permitted to inspect Bedroom #1 or the garage of the facility. Administrator claims that this is a separate address, however it is still part of the same address according to the facility sketch and plan of operation that is held with the licensing agency. ·The facility sketch located in the facility, does not match with the current facility sketch on file with the licensing agency. It has since removed Bedroom #1 and the garage, but the licensing agency does not have this on file nor has received it. · One (1) resident’s (R1’s) bathroom does not have a window screen in their bathroom. Operational Requirements: · Fire clearance was approved by LA County Fire Department for a capacity of six (6) non-ambulatory residents, and a hospice waiver approved for one (1) residents. · Care and supervision to meet the clients’ needs was observed. · There is currently no PUB 475 poster “See something Say something” poster located in the facility. Staffing: · Five (5) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All five (5) staff records have a health screening with a Tuberculosis clearance, First Aid/CPR trainings that are active, and required annual trainings. · Two (2) staff members (S2 and S3) do not have documented training on file pertaining to dementia care, postural supports, hospice care, and restricted health conditions. · Two (2) caregivers (S2 and S3) who work at the facility are not currently associated to the facility, and need to be transferred from their previous facility. · Administrator’s certificate expires on 1/31/2028. Resident Rights/Information: · Physician orders were reviewed for five (5) resident files. · Medications were also reviewed for five (5) residents. · A death report was not submitted to the licensing agency for one (1) resident (R3), who passed away on 6/23/2026. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. · One (1) Resident (R1) has not had a reappraisal conducted within the past twelve (12) months. · One (1) Resident (R2) does not have a Pre-Admission Appraisal on file and were admitted this year. · One (1) Resident (R1) does not have a current LIC602A (4/25) on file, and the one they do have is not fully completed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have are assisted with medication management by staff. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) that is posted in the facility is the older single-paged LIC610E form, it is not the current LIC610E form that is 9-pages. · The last emergency and disaster drill was not documented within the past three (3) months. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. · One (1) resident (R1) has half-rails on their bed, however they do not have a physician’s order for the rails. · One (1) resident (R2) has full-rails on their bed, however they are not on hospice. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit is documented on the LIC809D pages. Civil Penalties were issues on the LIC421IM, LIC421BG, and LIC421FC pages. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Mylyn Castillio, caregiver for the facility, and explained the purpose of the visit. Administrator Tiffany Sasada was notified of the visit by phone call. There are two (2) residents residing within the home. The following 4 (CARE) tool domains were observed and reviewed: Physical Plant/Environment Safety, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Physical Plant · LPA conducted a tour of the facility including three (3) resident bedroom, the living room, dining room, kitchen, and backyard area. Facility was observed to be clean and in good repair. Resident Records: LPA reviewed the records for two (2) residents for appraisals, physician's reports, admissions agreements. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incidental Medical and Dental · Medications along with the Medication Administrator Records (MARs) were reviewed for two (2) residents. Due to time constraints, the annual inspection will be completed at another date. Exit interview held and a copy of the report was provided. .the state’s words, verbatim · CDSS document, Jun 26, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Ivonne Lopez, caregiver for the facility, and explained the purpose of the visit. Administrator Tiffany Sasada was notified of the visit by phone call. There are five (5) residents residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Three (3) staff did not have their medical assessment with TB clearance available for review during the annual inspection. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, all six (6) of whom may be non-ambulatory, and a hospice waiver approved for one (1) resident. The facility consists of a kitchen, a dining room, a living room, three (3) resident bedrooms, two bathrooms of which Restroom #1 had a hot water temperature reading of 122.y Degrees Fahrenheit, and Restroom #2 which had a hot water temperature reading of 123.4 Degrees Fahrenheit, which were both over the required range of 105 – 120 Degrees Fahrenheit. LPA requested to tour bedroom #1 identified on the facility sketch that Community Care Licensing Division (CCLD) has on file dated 11/2/2015, however LPA was not allowed to tour the room. One of the non-ambulatory residents of the facility is currently residing in the “multipurpose room” of the facility, rather than one of the identified resident bedrooms based on the current facility sketch on file dated 11/2/2015. CCLD will be following up with the fire department in regard to the facility’s use of the multipurpose room. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has a fully charged fire extinguisher kept in the facility. Operational Requirements: · Fire clearance was approved by LA County Fire Department for a capacity of six (6) residents, all of whom may be non-ambulatory, and a hospice waiver approved for one (1) resident. · Care and supervision to meet the clients’ needs was observed. Staffing: · Four (4) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Four (4) staff files were reviewed for criminal background clearance and training. · One (1) of the staff was not associated to the facility. · All four (4) staff members did not have current/valid CPR certificates available to review. Resident Rights/Information: · Physician orders were reviewed for five (5) resident files. · Medications were also reviewed for five (5) residents. · The Medication Administration Records (MARs) were not initialed by staff on 8/13/2025 and 8/14/2025 during the initial visit conducted on 8/14/2025. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. · One (1) resident does not have their physician’s report on file. · Two (2) residents did not have a completed Pre-placement appraisal on file. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · Annual staff retraining on topics related to dementia care, hospice care, postural supports, and restricted health conditions were not available to be reviewed. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit is documented on the LIC809D pages, and civil penalties are documented on the LIC421IM and LIC421BG pages. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with William Del Rio, caregiver for the facility, and explained the purpose of the visit. Administrator Eliza De Honor arrived shortly thereafter. There are four (4) residents residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Staffing: · Three (3) full-time staff members provide care and supervision to the clients. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Due to time constraints, the annual inspection will be completed at another date. Exit interview held.the state’s words, verbatim · CDSS document, Aug 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Daniel Konishi and Christine Wong, conducted a required annual inspection using the Inspection Tool. LPAs met with the Manager, Tiffany Sasada and the purpose of the visit was discussed. Infection Control: The facility has a Infection Control Plan in place. Personal Protective Equipment (PPEs) were observed. The facility continues to practice hand washing and disinfecting. Operational Requirement: Hospice Waiver for 1 is approved. A fire clearance is in place. Liability Insurance in the amount of at least ($1,000,000.00) per occurrence and ($3,000,000.00) in total annual aggregate is in place and expires 07/11/2024. Structure/Physical Plant: The facility is part of a single-story home located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, locked storage kitchen cabinet for sharps, (3) resident rooms, (2) bathrooms for residents; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for resident use. There’s a laundry area; with washer and dryer. The residence is equipped with central air conditioning. There is an inaccessible fireplace. Adequate accommodations observed throughout facility. Hallways free and clean of obstruction and debris. All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Smoke and Carbon Monoxide Detectors Electrical & connected. Battery operated & working, all detectors tested and operational. Toxins are locked/stored for staff use only. Hot Water temperature measured between 109.5 -113 degrees which is within Title 22 Regulation. Staffing: There is sufficient number of staffing. Personnel Records/Staff Training: LPAs reviewed two (2) staff files but Staff #1 does not have health screening, TB Test result and not associated with the faciltiy, and LPA was not able to review staff training hours. Administrator's RCFE Certificate is effective through 06/17/2025. Resident Rights-Information: Resident personal rights is not posted. Per Administrator, facility provides internet services to all residents and have access to the facility phone. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility has a Resident Council. Facility provides equipment and space to accommodate both outdoor and indoor activities. Food Service: All food and adequate utensils such as, dishes, cups, bowls, and plates observed. Sufficient food supply and emergency food supplies are stored in the kitchen. Incidental Medical and Dental: Four (4) centrally stored resident medications inaccessible to residents were reviewed; containing 30-day supply of medications. Medical and dental transportation is provided. First aid kit observed. Resident Records/Incident Reports: Resident files are maintained at the facility. A total of four (4) resident files were reviewed. They contained admission agreements, Physician's Reports, TB clearance. One of the resident was missing the pre-admission appraisal. RCFE complaint poster were observed posted on the wall near the dining area. LPAs did not observe any resident's personal right posted in the facility. Disaster Preparedness: The facility does not have an updated Emergency and Disaster Plan LIC 610E in place. Records of resident Appraisal and Needs services plans are part of Emergency training. Residents with Special Health Needs: Currently, one (1) resident is on hospice care and one (1) resident is on home health. Half bed rails for mobility assistance were observed in some resident beds but no physician order in residents' files. Deficiencies are being cited per Title 22 Regulations. See 809-D page. Exit Interview conducted with Tiffany Sasada and a copy of this report and appeal rights discussed and provided.the state’s words, verbatim · CDSS document, Jun 13, 2024

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.