Correction check·December 23, 2025

( Licensing Program Analysts (LPAs) Elena Mallett and Cynthia Chan conducted an unannounced POC visit and met with Staff in Charge, Adrianne Gray regarding citations issued on 12/11/25. The purpose of the visit was to inspect the facility to ensure the deficiencies cited on 12/11/25 were corrected and were discussed. Staff Adrianne Gray stated Licensee Percy Olidan has gone to the Phillipines on a personal matter and has not been at the facility since 3:30 AM on 12/11/25. Staff Adrianne Gray stated Licensee was told about deficiencies from 12/11/25 visit. On todays visit, LPA Mallett observed the following deficiencies have not been corrected: Per Staff Licensee stated she will handle the POCs upon return. HSC 1569.618(c)(3) - Other Provisions (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. Based on record review, the licensee did not comply with the section cited above has 2 out 3 Staff , Staff 2 and 3, did not have a current CPR training on file and 3 out 3 Staff ( S1, S2 and S3) did not have current First Aid training on file. This affects 3 out of 3 residents which poses/posed a potential health, safety or personal rights risk to persons in care. As of today's visit S2 and S3 did not have current CPR and First Aid training on file,On today's visit Staff was using unoccupied residents room. Civil Penalties issued on today's visit in the amount of $ 400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. CCR 87411(f) Personnel Requirements -General (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. Based on a record review, the licensee did not comply with the section cited above in 1 out of 3 staff , S3, did not have a TB test in their file which poses/posed a potential health, safety or personal rights risk to persons in care. On today's visit S3 did not have a TB test in their file. Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. HSC 1569.605 Other Provisions On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests 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 or its employees. Based on interview with Licensee current Liability Insurance is available. This affects 3 out of 3 residents in care. On today's visit Current Liability insurance has not been provided.Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. CCR 87307(d)(2) - Personal Accommodations and Services (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by : On LPAs observed curtain rods in the living room were not properly secured to wall, the closet doors in both resident rooms did not slide back and forth properly, and there was debris in the carport. Based on observation, the licensee did not comply with the section cited above and this affected 3 out of 3 residents which poses/posed a potential health, safety or personal rights risk to persons in care. On today's visit the curtain rod was not secured to the walls, the closet doors had not been fixed and the debris in the carport was present. Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. CCR 87204(a) - Limitations-Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license. Based on interview and observation the licensee did not comply with the section cited above in 1 out of 3 residents rooms were not used by residents but by S3. This affects 3 out 3 residents which poses/posed a potential health, safety or personal rights risk to persons in care. On today's visit Staff was using unoccupied residents room. Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. CCR 87465(e) - Incidental Medical Care... For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. Based on record review, the licensee did not comply with the section cited above in1 out of 3 residents, R1, which poses/posed a potential health, safety or personal rights risk to persons in care. On today's visit, the PRN medication was not available for Resident 3. Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. CCR 87405(a) All facilities shall have a qualified and currently certified Administrator... Based on observation, interview and record review], the licensee did not comply with section above as there was no documentation of a qualified and certified administrator this affects 3 out of 3 residents which poses/posed a potential health, safety or personal rights risk to persons in care. On today's visit there was no documentation of a qualified Administrator working for the facility. Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. CCR 87305(a) - Alterations to Existing Buildings or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. Based on observation and record review the licensee did not comply with the section cited and this affected 3 out 3 residents in care which poses/posed a potential health, safety or personal rights risk to persons in care. On today's visit the building permits were not provided for the converted storage room and bathroom by breaksfast nook that were not on the facility sketch.Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. An exit interview with Staff Adrianne Gray was conducted and the failure to correct deficiencies cited per Health and Safety Code and Califronia Code of Regulations Title 22 was discussed.The Civil Penalties assessed today was discussed . A copy of Appeals Rights was provided along with a copy of this Licensing Report. A copy of this Licensing Report will be emailed to Licensee Percy Olidan. CCR 87458(c)(1)(A) Medical Assessment (c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional' diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis This requirement is not met as evidenced by: On 12/09/25 visit Resident 1 (R1) file did not contain a TB test At today's visit Resident 1's file did not contain a TB test.Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected. CCR 87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: On 12/11/25 it was observed that the smoke detectors throughout the facility (living room, hallway, one resident room and staff room) were either missing or non operational. On today's visit room with missing smoke detector was locked and inaccessible. Civil Penalties issued on today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected.