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Inspection visit

Routine inspection

EVONNE'S RESIDENTIAL CARE HOME #1License 4352023923 citations on this visit
3 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Philomena Agbontaen. During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. while touring the facility kitchen with ADM, LPA observed there was no staff or residents in kitchen. LPA observed an unsecured half orange tablet on the kitchen table. S1 stated the half tablet belonged to resident R4. S1 stated there is a hold parameters for medication M1, based on the blood pressure. ADM stated R4's blood pressure was too low and the medication was on hold. S1 stated he/she had forgotten to put the medication tablet back. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 112 degrees F in resident bathrooms. Fire extinguisher was serviced in May 12, 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on December 23, 2025. LPA reviewed 3 staff records. LPA reviewed facility records for 3 residents. LPA observed 3 Out of 3 resident (R1-R3) Needs and services plans were not updated. ADM stated she has not had the chance to update them. LPA reviewed 3 resident medications and centrally stored medication records. R3 had 4 medications bubble packs that were not listed. Furthermore, R3's had a medication bubble pack start date that was incorrect. R1 had two medications that were not listed on the centrally stored medication record. R2 had 1 medication not listed on the centrally stored medication record. A deficiencies are being cited during today's visit, see LIC809-D. This report was reviewed with Administrator Philomena Agbontaen and a copy of the signed report was provided. Appeal rights were provided.

Citations

3 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.

  • 87463(a)Type B

    Update reappraisal at required intervals

    Based on interview and record review, the licensee did not comply with the section cited above. LPA reviewed facility records for 3 residents. LPA observed 3 Out of 3 resident (R1-R3) Needs and services plans were not updated. ADM stated she has not had the chance to update them. This poses/posed a potential health, safety or personal rights risk to persons in care.

  • Store centrally held medications in locked secure place

    Based on observation, the licensee did not comply with the section cited above. LPA observed an unsecured half orange tablet on the kitchen table. S1 stated he/she had forgotten to put the medication tablet back. This poses/posed a potential health, safety or personal rights risk to persons in care.

  • Record centrally stored prescriptions and refill data

    Based on record review and interview, the licensee did not comply with the section cited above. 3 Out of 3 residents had medications that were not listed on their centrally stored medication record. This poses/posed a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the February 25, 2026 inspection of EVONNE'S RESIDENTIAL CARE HOME #1?

This was an inspection of EVONNE'S RESIDENTIAL CARE HOME #1 on February 25, 2026. 3 citations were issued: 3 Type B.

Were any citations issued to EVONNE'S RESIDENTIAL CARE HOME #1 on February 25, 2026?

Yes, 3 citations were issued (0 Type A, 3 Type B). The first citation was for: "Based on interview and record review, the licensee did not comply with the section cited above. LPA reviewed facility re..."

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.