Non-compliance follow-up·September 23, 2025

At approximately 9:45 AM Licensing Program Analyst (LPA) Star Stevenson arrive unannounced to conduct a Non-Compliance case management visit and was greeted by caregiver Ronald Lazaro who has Designation of Facility Responsibility (RP). Ronald called licensee Imelda Padama, who arrived at approximately 10:20 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with a Hospice waiver for two (2), an approved dementia plan, and fire clearance for capacity of six (6) residents; five (5) non-ambulatory and one (1) bedridden resident in room #4 only. Facility currently has five residents in care with their newest resident having moved in on 09/18/2025. Licensee was advised of the need to develop an Appraisal Needs and Service plan(LIC625) for their newest resident. At approximately 10:20 AM LPA conducted a facility inspection with RP and observed that all medicines were now centrally stored and locked and toxins that could pose a risk to residents in care locked as well. In addition, a cubicle in the garage that once had over night sleeping furniture, continues to simply have additional paper goods, PPE and supplies. Facility was a comfortable temperature, clean and without odors. At approximately 11:00 AM LPA conducted a file review and interview with licensee and it was determined that four (4) out of five (5) residents were missing required elements of their records with R1, R2, R3 and R4 missing Consent for Emergency Medical treatment (LIC627C), as well as R2, R3, R4 missing signed Personal Rights (LIC613C). Licensee was reminded that in the case of dementia, records would need to be signed by responsible parties. (repeat Type B citation assessed) At approximately 11:45 AM LPA conducted file review of five (5) staff members with one (1) staff member noted to have TB clearance but not a full health screening and a technical violation was issued. Licensee was advised to ensure that complete records for staff were present to avoid a Type B violation and potential monetary penalty in the future. Continued on LIC809C continued from LIC809 Deficiencies and technical violations 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 this document confirms receipt