Routine inspection·September 5, 2025

At approximately 9:30am, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by Edwardson Manalo, Licensee. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for six (6), is approved for all non-ambulatory residents, and is vendored with the North Bay Regional Center (NBRC). At approximately 10:30am, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a two story home, was a comfortable temperature, and passageways were free from obstructions. All residents live on the first floor of facility. Staff and tenants who live on the second floor are background screened and associated to the facility. LPA observed egress devices activated on all facility doors. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and 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 observed locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA inspected a locked storage shed in the backyard which contained care equipment. LPA observed residents watching TV in their bedrooms and in the facility's common area. Continued on LIC809-C... Continued from LIC809C... Facility has internet service and an internet access device which is designated for resident use. The telephone was tested and was operational during inspection. Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 03/2025. Emergency Disaster Plan was reviewed and updated 09/2025. Facility conducts quarterly disaster drills with the most recent drill conducted 08/2025. LPA observed PPE, a first aid kit, flashlights, and a generator for emergency preparedness. At approximately 11:15am, LPA conducted file review of three (3) staff and three (3) resident files. Three (3) of three (3) staff files reviewed contained all the required documents including proof of current First Aid and CPR certifications. Staff 1 (S1) and Staff 2 (S2) records were missing proof of all 20 hours of the required annual training, (see LIC809D). Three (3) of three (3) staff files reviewed were observed to have the required initial training hours. Three (3) of three (3) resident files reviewed contained all the required documentation. Licensee states that residents' families and facility staff coordinate medical and dental appointments as well as transportation to a from these appointments. Medications and medication records were inspected and the logs were observed maintained in compliance with regulation. Licensee provided LPA with a copy of a surety bond and agrees to submit an affidavit regarding resident cash resources to the Department for any P&I the facility manages for residents in care. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC400 - Affidavit Regarding Client/Resident Cash Resources Proof of Liability Insurance (updated policy) 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, or repeat violations, may result in a civil penalty assessment. Appeal rights provided to Licensee. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.