Routine inspection·May 5, 2026

At approximately 09:50 AM Licensing Program Analyst (LPA) Stevenson arrived unannounced for the purpose of conducting a required annual inspection and quarterly Case Management-Legal/Non-compliance (NCC) Inspection and met with caregiver Lorna Valasquez who has Designation of Facility Responsibility (RP). House Manager Gwen Martinez was advise of today's inspection. House Manager arrived at approximately 10:15 AM to further assist with today's inspection. LPA was advised that there were four (4) residents in care, all of which were present during today's inspection. Facility is licensed for six (6) residents, five (5) of which can be non-ambulatory, one (1) bedridden and has a hospice waiver for three (3) residents. This facility was placed on a Non-Compliance Conference (NCC) on 06/26/2024 for a two-year term by Community Care Licensing (CCL); Concerns addressed in that NCC meeting on 06/26/2024 were: Administrator Duties and Qualifications Active Administrator in place for facility oversight per regulation Clearing Plans of Correction (POCs) Reporting Requirements Timely response to CCL when communication is engaged Continued on LIC809C Continued from LIC809 House manager Gwen Martinez was again, for the third time, advised that licensee Triune,INC continues to be in suspended status with the Franchise Tax Board (FTB). In addition LPA advised licensee that the department has not received recent updates on their efforts to get in good standing with the FTB and that this was in violation of the NCC goal of Magnolia Gold Home Care having more, "Timely responses with Community Care Licensing (CCL) when communication is engaged"; a concern that was raised during the last NCC inspection. At approximately 10:45 AM a tour of the facility was conducted and facility was found to be clean and well organized, and a comfortable temperature and without odors. Residents were clean and dressed appropriately. There was an ample supply of hygiene products for residents' care. There was also an ample supply of healthy perishable and non-perishable food as required by Title 22. Water temperature in 2 of 2 bathrooms measured within regulation of 105 -120 F. There was one new fire extinguisher observed to be fully charged. Smoke detectors/carbon monoxide detectors are centrally wired and tested to be functional. The front and back yards are well maintained and the back yard pool is fenced and secured as required by regulation. There is also a covered patio with seating for outdoor activities and visits. There are comfortable couches and chairs in the living room with television and simple games available. Soaps and toxins, as well as sharps were locked securely and inaccessible to residents. A toilet in the back bathroom is noted to rock and be unstable and licensee is advised to make toilet secure so as to provide a stable toilet for residents to use. (Technical Advisory for CCR 87303(a)) The last Emergency/Disaster drill was held on 03/05/2026. At approximately 11:45 AM LPA reviewed four (4) of 4 resident records and all 4 had complete records except resident (R1) was noted to be missing an annual health assessment. A discussion with House Manager had House Manager calling R1's responsible party to request copies of the numerous professional assessments R1 has had over the last year so as to be in compliance with CCR 87463(h)(1) of Resident Records/Incident Report Continued on LIC809- C Continued from LIC809-C At approximately 12:15 PM LPA reviewed six (6) of 6 staff files, including two (2) new staff and found all 6 to have required documentation except staff (S1) although with a clear TB test was missing a health physical and licensee is arranging to get a copy from the staff member not working today. Facility does not handle resident P&I money. At approximately 1:00 PM House Manager and LPA reviewed Medicine Administration and record keeping and found Medicines to be centrally stored and secure. In two (2) out of four (4) records, House manager and LPA observed instances of medicines as having been documented as having been administered but actually had been being termed out by MD order and not in facility, as well as a second instance in which a medicine was ordered every other day and blister packed as such, but was documented as having been given everyday. A type B citation for violation of CCR 87465(c)(2) Incidental Medical and Dental is levied and Plan of Correction (POC) issued . Licensee is asked to provide the following documents by 06/04/2026 to update the facility file including: 1) Updated LIC 308 Designation of Facility Responsibility (1 person per fo rm) 2 ) Copy of updated Liability Insurance 3)LIC 9020 Resident Roster 4)LIC 500 Updated Personnel roster 5 ) Updated and signed LIC 610E Emergency Disaster Plan 6)Update Lease Agreement or Deed 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 RP Lorna Valasquez and Appeal rights were given.