Ward Residential Care Home III

Type of visit: Required - 1 Year

At approximately 9:10 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Licensee Alicia Poquiz arrived at approximately 10:05 AM. Ward Residential Care Home III is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) residents four (4) of which may be non-ambulatory residents. The facility has a Hospice Waiver for three (3) residents. Upon arrival, LPA was informed that there were six (6) residents in care and two (2) staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:35 AM, LPA toured the facility. All exits were clear and unobstructed. The facility's one (1) fire extinguisher is brand new, having recently been purchased. The facility was sufficiently lighted. LPA inspected four (4) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. The facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 6/20/2026. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 10:30 AM, LPA reviewed five (5) resident files. Five (5) of five (5) resident files were observed with all required documentation. LPA reviewed four (4) staff files. Four (4) of four (4) staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA audited Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle residents’ monies for personal and incidental items. Annabelle Antonio’s Administrator Certification 7028257740 is current with an expiration date of 11/10/2026. Alicia Poquiz’s Administrator Certification 70014027740 is current with an expiration date of 11/20/2027. LPA requested the following document be submitted to Community Care Licensing by 9/6/2026: LIC 610E Emergency Disaster Plan No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Licensee Poquiz. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 6, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff not meeting resident care needs

At approximately 3:00PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to continue a complaint investigation regarding the above allegation and met with Licensee Alicia Poquiz. Staff not meeting resident care needs – Reporting Party (RP) alleges that resident (R1) is not receiving proper care related to their diagnosis and has not received any medical attention in four (4) years. During the course of this investigation LPA conducted interviews, made observations, and reviewed records. Review of current LIC602-Phsycian Report as well as hospital discharge paperwork indicated that R1 attended medical appointments two (2) times in 2026, and the previous LIC602-Physican Report was dated 5/2025. Review of Appraisal Needs and Service plan indicated that resident appraisal is being conducted yearly or upon a change in condition. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Nothe state’s words, verbatim · CDSS document, Apr 21, 2026 · control 21-AS-20260320120237

Type of visit: Required - 1 Year

At approximately 9:15 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Caregiver. Licensee Alicia Poquiz was contacted and arrived at approximately 10:30 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for three (3), with zero (0) Hospice residents currently in care, and is approved for four (4) non-ambulatory residents. At approximately 9:50 AM, LPA initiated a tour of the facility with Caregiver and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were observed charged and last inspected 6/24. Licensee stated fire inspection will be occurring 7/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 105.4 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed one locked shed in the backyard which was inspected and observed to be a staff room. Facility has an internet access devise and internet available to clients in care, and the phone was tested and operational during today's inspection. Continued 809C... Continued from 809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 4/25. LPA observed facility's infection control plan and emergency disaster plan. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 11:00 AM LPA conducted review of three (3) staff records. All required documentation present. At approximately 11:30 AM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 11:40 AM LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. Renewal paperwork for Administrator Certification has been submitted, Licensee shall submit certification to CCL when received. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Licensee, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jun 17, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 9:00 AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by caregiver, Meriam Binalirao. Licensee, Alicia Poquiz arrived shortly after at approximately 10:45 AM. The facility is a single story home licensed for two (2) ambulatory residents, four (4) non-ambulatory residents and a hospice waiver capacity of three (3). The facility currently provides care for seven (7) residents. Facility is operating above the licensed capacity. Six out of seven residents were at home. Two out of seven was sleeping in her room, two out of seven were in the living room watching television, two of seven were outside smoking, and one of seven was away with his father. In addition, there are two (2) residents with a diagnosis of dementia At approximately 09:15 AM, LPA and Caregiver toured the building and grounds which was found to be clean. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility garage but some toxins found unsecure.. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen drawer. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. LPA advised Caregiver all hallways and non-private bathrooms are required to have night light Water temperature measured within regulation between 114 and 118 degrees F at three of three faucets accessible to residents. One out of one fire extinguisher was inspected and charged. Nine out Nine interconnected smoke detectors and two out of two carbon monoxide detectors were present, inspected and found to be in working order. There was enough lighting in all common areas and resident rooms. Continued on 809C Continued from 809 Medications located in designated cabinet were found to be secured. LPA conducted a spot check of medications and found medication administering pre-pouring error. Per approved Fire Inspection Facility Sketch dated 07/22/2022, Licensee is using designated Resident Bedroom #2 as a Staff Room and designated Staff Bedroom as a Resident Bedroom. In addition, the two Extra bedrooms located next to the designated Staff Room is being used as Resident Rooms. Licensee to provide updated Facility Sketch to CCLD for new Fire Inspection Request. At approximately 10:30 AM, LPA reviewed Seven of Seven resident records which were all found to be well organized. At approximately 11:39 AM, LPA reviewed two out of two staff records which were all found to be well organized. Medication records contained physician's orders for each resident. Administrator Annabelle Antonio Administrator Certification 7028257740 is current and expires on 11/20/2024. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC9020 Register of Facility Clients/Residents LIC610- Disaster Plan (to include non-local evacuation site) Dementia Care Plan Job Description/Personnel Policies Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alicia Poquiz and Appeal rights were given.the state’s words, verbatim · CDSS document, Jun 21, 2024

The state marks this report as 9 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Ward Residential Care Home III for the purpose of conducting a Case Management-Annual Continuation. LPA was greeted at the door by Caregiver, Meriam Binolirao, and was granted access into the facility. During the Case Management-Annual Continuation, Emergency Disaster Plan was reviewed during this inspection. Infection Control Plan needs to be updated (See LIC 9102-Technical Violation). LPA educated the Licensee on the importance of having an updated an Infection Control Plan and to provide updates yearly. Staff and three clients were interviewed and the remainder of the clients were not available for an interview. LPA requested the following documents to be sent: LIC 500-Personnel Report Updated Infection Control Plan Updated Emergency Disaster Plan LIC 308-Designation of Responsibility LIC 400- Affidavit regarding Client Cash Resources Liability insurance Control of Property Resident Roster Staff Roster No deficiencies were cited during today's Case Management-Annual Continuation. Exit interview was conducted and a copy of this report was given to the Licensee.the state’s words, verbatim · CDSS document, Sep 29, 2023

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.