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Inspection visit

Routine inspection

PACIFIC CARE HOME IIILicense 4156009335 citations on this visit
5 citations recorded

Inspector’s narrative

What the inspector wrote

On March 3, 2026, Licensing Program Analyst(LPA) Murial Han and IB investigator Gina Dutta conducted an unannounced annual inspection. LPA and IB investigator were greeted by caregiver, Emily Soriano. LPA explained the purpose of the visit. Facility supervisor, Moddie Andaya and licensee, Wilhelm Ick arrived shortly thereafter and assisted with the inspection. LPA toured facility and grounds. No accessible bodies of water. LPA toured inside and outside including all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed 5 resident rooms. Rooms were spacious and included all required furnishings. Bathrooms were observed to be clean; equipped with paper towels, soap, grab bars, and non-skid mats. Hot water temperature in the kitchen, and bathroom was measured at 108- 113 degrees F. 2 days for perishables and & 7 days non-perishable were observed to be present. The facility is approved for 3 hospice and 1 bedridden; during today's visit, there are 5 resident and 2 of which are on hospice care. Medications, toxins, chemicals were observed to be locked and inaccessible to residents in care. Emergency drills were reviewed. Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguisher was last inspected on 10/9/2025. A review of (5) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. During the tour of the facility, LPA and IB investigator observed the garage consisted of a metal/wooden frame with a folded cushion on top (similar to a Fulton bed), Rosary, clothes with staff clothing, staff medication, shoes, comb, etc. In addition, during the medication review, LPA observed medication was removed from its original containers, and poured into a pill organizer container for the next day. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with administrator and supervisor. A copy is provided and the appeal rights.

Citations

5 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87307(a)Type B

    Living accommodations aligned with facility function

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA and IB investigator observed clothing, Rosary, futon bed, medication, comb, shoes in the garage which poses/posed a potential health, safety or personal rights risk to persons in care.

  • Maintain records of centrally stored medication dosages

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above LPA and IB investigator observed R2, R3 and R4's centrally stored medication records were incomplete and medication was not logged which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 87465(e)Type A

    Require physician order and label for PRN medication

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA and IB investigator observed an over the counter Blink Eye Drop in R2's room without a physician's order which poses an immediate health, safety or personal rights risk to persons in care.

  • Keep prescriptions in original containers

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA and IB investigator observed medication was removed from its original container which poses an immediate health, safety or personal rights risk to persons in care.

  • 87608(a)(5)(B)Type A

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA and IB investigator observed R3 has full bedrails which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the March 3, 2026 inspection of PACIFIC CARE HOME III?

This was an inspection of PACIFIC CARE HOME III on March 3, 2026. 5 citations were issued: 3 Type A (serious) and 2 Type B.

Were any citations issued to PACIFIC CARE HOME III on March 3, 2026?

Yes, 5 citations were issued (3 Type A, 2 Type B). The first citation was for: "Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as LPA an..."

What type of inspection was this?

This was an inspection. Inspections are conducted by CCLD as part of their licensing oversight.

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.