Pacaldo-yee
What is an RCFE with Memory Care?
A Residential Care Facility for the Elderly (RCFE) is a non-medical residential care home licensed by California CDSS under Health & Safety Code §1560. Residents receive help with daily living activities such as bathing, dressing, and medication management. An RCFE with a Memory Care designation is additionally required by California Title 22 (§87705 and §87706) to provide specialized staff training in dementia care, individualized care plans for residents with cognitive impairment, and appropriate supervision protocols — requirements that go beyond a standard RCFE license.
999 Torrano Ave · Hayward, 94542
Record last updated April 20, 2026.
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Quick facts
Memory care context
Pacaldo-yee is a California-licensed Residential Care Facility for the Elderly (RCFE) with 14 beds. The operator advertises memory care services, though this designation is not formally documented in CDSS licensing data. California Title 22 requires all RCFEs serving residents with dementia to comply with §87705 and §87706, which govern care planning, staff training, and supervision standards for dementia care. State records show no citations specifically under these dementia-care sections. However, the facility's inspection history includes 13 reports with 25 total deficiencies—11 Type A (actual harm) and 14 Type B (potential for harm). Three complaints are also on file. The most recent inspection occurred on April 15, 2025.
Questions to ask on your tour
Based on Pacaldo-yee's state inspection record.
State records show 11 Type A deficiencies, which indicate actual harm to residents—what were the circumstances of these citations, and what corrective actions has the facility implemented?
Three complaints have been filed with CDSS—can you describe what those complaints involved and whether they were substantiated?
With 25 total deficiencies across 13 inspections, what systemic changes has the facility made to reduce recurring compliance issues?
The operator advertises memory care but CDSS records do not show a formal dementia-care designation—what specific training do staff receive for residents with Alzheimer's or other dementias, and how is completion documented?
State records
California CDSS · Community Care Licensing Division- License number
- 019201136
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 14
- Operator
- Pacaldo Yee
Inspections & citations
13
reports on file
25
total deficiencies
11
Type A (actual harm)
ComplaintDecember 4, 2025No deficiencies
Inspector: Catherine Lin
Inspector notes
On 7/21/2022 at 11:25 AM, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct case management while conducting an initial 10-day complaint investigation. LPA met with staff Kester Orendain, Manager Tessa Cruz arrived at a later time. Upon entry, LPA learned that there was 1 resident tested Covid-19 positive on 7/19/22 and exhibiting symptoms. LPA observed that the isolation room door was open. Caregiver S1 stated that they let the door open so that they could check on the resident without opening the door each time. All other resident's rooms are opened and residents didn't have mask on. LPA observed there has no set of PPE supplies by the isolation room, and no isolation signs on the door. S1 stated that PPE supplies were by the main door where they were donning and doffing. LPA observed staff did not follow infection control protocol. The above deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Manager. LIC809D, Appeal Rights and a copy of this report provided.
InspectionApril 15, 2025No deficiencies
Inspector: Kelly Nguyen
ComplaintFebruary 25, 2025No deficiencies
Inspector: Catherine Lin
Inspector notes
On 4/21/22 at 1-20 PM, Licensing Program Analysts (LPAs) C. Lin and L. Fici arrived unannounced to conduct Pre-licensing Required inspection for changing of ownership. LPAs met with applicant, Juliet Pacaldo and explained the purpose of the visit. The facility currently has 9 residents. LPAs toured facility including but not limited to 7 bedrooms, 3 bathrooms, kitchen, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside cabinets. There is sufficient lighting throughout facility. Room temperature was maintained at 70 degrees F. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 12/12/2021. Prior to licensure, the following shall be corrected and submitted to CCL by 04/29/2022. Hot water temperature was 129 degrees F. First-aid kit was not completed. Laundry detergent and cleaning supplies were observed unlocked in the laundry room. Medication was observed unlocked in two residents' room and kitchen. Knives and scissor were observed unlocked in the kitchen A broken dresser was observed in one of the bedrooms Alarm needs to be installed in the exit door to backyard Issues were noted during inspection. LPAs observed that facility is not ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted with applicant and a copy of this report provided.
Other visitMay 10, 2024Type A5 deficiencies
Inspector notes
On this day, at around 9:30 am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection. LPA met with Administrator, Digna Ramos, and explained the purpose of the visit. The facility has an approved fire clearance for 11 non-ambulatory and 3 bedridden residents. The facility has an approved hospice waiver for 4 residents. LPA observed 3 staff working during the visit. During the visit, LPA inspected the facility inside and out, including but not limited to resident rooms, bathrooms, living/dining area, kitchen, and backyard. Passageways were observed to be clear and free from obstruction. There was sufficient lighting. Smoke detectors are interconnected. The first aid kit was observed to be complete . At 10:30 am, LPA reviewed 5 residents' files; 5 out of 5 have current physician reports. At 12:10 pm, LPA reviewed 5 staff files; 5 out of 5 have current TB, CPR, and First Aid certificate. ***continuation on Lic 809C*** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The following deficiencies were observed: - At around 12:51 pm, LPA observed expired canned goods/ food (cabbage/ Lettuce spoiled) inside the cabinets and refrigerator. - At around 12:55 pm, LPA observed that unlocked medication was left in the cabinet and on top of the kitchen counter. LPA observed unlocked over-the-counter medication in the resident’s room. - At around 1 pm, LPA observed prescribed medication (TRESIBA) left unlock in the refrigerator. - At around 1:10 pm, LPA observed a knife in the cabinet unlocked. - At around 1:30 pm, LPA observed hot water measured at 136.3 degrees Fahrenheit residents' shared bathroom. Civil Penalties in the total amount of $750 are assessed today for failure to meet the POC date/repeated for deficiencies. Exit interview conducted. A copy of this report, appeal rights, and LIC421FC are provided.
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degre…
Based on observation, hot water measured at 136.3 degrees Fahrenheit residents' shared bathroom. The licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/16/2025 Plan of Correction 1 2 3 4 Administrators agree to turn the hot water down and submit a photo to CCLD by the POC date.
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
Based on observation, the licensee did not comply with the section cited above by leaving a knife in the cabinet unlocked. which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/15/2025 Plan of Correction 1 2 3 4 Staff locked up the knife during inspection. Deficiency Clear.
(h) The following requirements shall apply to medications which are centrally stored:
Based on observation the licensee did not comply with the section cited above by having unlocked medication was left in the cabinet and on top of the kitchen counter. LPA observed unlocked over-the-counter medication in the resident’s room, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/16/2025 Plan of Correction 1 2 3 4 Administrators agree to lock up all medication and submit a photo to CCLD by the POC date. The administrator will condu…
(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (A) The preservation of medicines requires refrigeration, if the resident has no private refrigerator.
Based on observation, the licensee did not comply with the section cited above by having prescribed medication (TRESIBA) left unlock in the refrigerator, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 04/15/2025 Plan of Correction 1 2 3 4 Staff locked up the medication in the lock box in the refrigerator during inspection. Deficiency Clear.
(b) The following food service requirements shall apply:
Based on observation the licensee did not comply with the section cited above by having expired canned goods/ food (cabbage/ Lettuce spoiled) inside the cabinets and refrigerator, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/22/2025 Plan of Correction 1 2 3 4 The administrator will conduct an in-service training for all staff, including the topic and the signature of the staff attending to CCLD by the POC date.
InspectionMay 9, 2024Type A15 deficiencies
Inspector: Kelly Nguyen
Inspector notes
On this day at around 9:15 am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a continuation annual required inspection. LPA met with Co-Administrator, Paula Madrigal. LPA was informed by Co-Administrator that Administrator, Juliet was out of town, and will return 5/17/24. The following deficiencies were observed: · at around 9:30am, LPA reviewed facility files (liability insurance expired on 2/2/22). · at around 9:40am, LPA reviewed facility files (emergency disaster plan is not up to date). · at around 10:00am, LPA reviewed facility files (there are no record of fire trill). · at around 10:10am, LPA reviewed facility files (facility do not have designation of administrative and staff assignments on files) · at around 10:20am, LPA reviewed resident’s files (not having PRN medication signed, dated written order from a physician). · At around 11:35am, LPA observed the storage room in the garage are being used for staff bedroom. Deficiencies were cited per Title 22 California Code of Regulations (refer to Lic 809D). Exit interview was conducted and Appeal Rights was provided to Co-Administrator Paula Madrigal.
(h) The following requirements shall apply to medications which are centrally stored:
Based on observation, the licensee did not comply with the section cited above by having mediation to centrally store, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 05/11/2024 Plan of Correction 1 2 3 4 Administrator will submit photo of all medication of residents in one centrally stored area to CCLD by POC date.
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degre…
Based on observation the licensee did not comply with the section cited above hot water measured at 130.3 degrees Fahrenheit residents shared bathroom. which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 05/11/2024 Plan of Correction 1 2 3 4 Administrator will submit photo of hot water adjustment to CCLD by POC date.
(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above.
Based on observation, the licensee did not comply with the section cited above by unlock medication are left in the cabinet, and in refrigerator. LPA observed unlocked over the counter medication in resident’s roomwhich poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 05/11/2024 Plan of Correction 1 2 3 4 Administrator will submit photo of all medication locked, and in a lock box to CCLD by POC date.
(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures.
Based on observation, the licensee did not comply with the section cited above by having expired can goods/ food inside the cabinets and refrigerator. which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 05/11/2024 Plan of Correction 1 2 3 4 Administrator will check and verify with staff on getting rid of all expired cans good/ food to CCLD by POC date.
(3) Ensuring that the use of oxygen equipment meets the following requirements: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall.
Based on observation, the licensee did not comply with the section cited above by not having 3 Oxygen tanks without a stand and not secured, which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 05/11/2024 Plan of Correction 1 2 3 4 Administrator will submit photo of oxygen tanks on stand, safely secured , or remove to CCLD by POC date.
On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,00…
Based on record review, the licensee did not comply with the section cited above by not having a current liability insurance (exp: 2/2/2022), which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/24/2024 Plan of Correction 1 2 3 4 Administrator will submit current liability insurance to CCLD by POC date.
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
Based on observation, the licensee did not comply with the section cited above by kitchen vent is in disrepair, and ceiling wall area observed crack, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/24/2024 Plan of Correction 1 2 3 4 Administrator will submit photo of kitchen vent and ceiling crack fix to CCLD by POC date.
Prior to construction or alterations, all facilities shall obtain a building permit.
Based on observation the licensee did not comply with the section cited above by 3 staff rooms in garage, separated by one door and two wall dividers are being alternated without a permit, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/31/2024 Plan of Correction 1 2 3 4 Administrator will obtain and submit a building permit or tear the wall down to CCLD by POC date.
(c) General storage space shall be maintained for equipment and supplies as necessary to ensure that space used to meet other requirements of these regulations is not also used for storage.
Based on observation, the licensee did not comply with the section cited above facility is using the storage room in the garage as a staff bedroom, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/17/2024 Plan of Correction 1 2 3 4 Administrator will submit photo of the storage room is being used as a storage room, and not used as a staff bedroom to CCLD by POC date.
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staf…
Based on record review, the licensee did not comply with the section cited above by staff not have CPR and First Aid certificate on file, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/17/2024 Plan of Correction 1 2 3 4 Administrator will submit all current staff CPR and First Aid Kit certifications to CCLD by POC date.
(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following informa…
Based on record review, the licensee did not comply with the section cited above by not having PRN medication signed, dated written order from a physician..., which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/24/2024 Plan of Correction 1 2 3 4 Administrator will submit records of PRN sign and dated by physician for all resident to CCLD by POC date.
(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal.
Based on record review, the licensee did not comply with the section cited above by not having resident admission agreement...on files, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/24/2024 Plan of Correction 1 2 3 4 Administrator will obtaine residents admission agreement, and submit to CCLD by POC date.
(b) The medical assessment shall include, but not be limited to:
Based on record review, the licensee did not comply with the section cited above by not having resident physician report on files, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/24/2024 Plan of Correction 1 2 3 4 Administrator will obtain residents physician reports and submit to CCLD by POC date.
(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following:
Based on record review, the licensee did not comply with the section cited above by not having an emergency and disaster plan on files, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/24/2024 Plan of Correction 1 2 3 4 Administrator will send emergency plan and disaster and submit to CCLD by POC date.
(b) The plan shall be subject to review by the Department and shall include: (1) Designation of administrative authority and staff assignments.
Based on record review, the licensee did not comply with the section cited above by not having designation of administrative and staff assignments on files, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 05/24/2024 Plan of Correction 1 2 3 4 Administrator will submit a designation of administrative and staff assignments and submit to CCLD by POC date.
InspectionJuly 29, 2023No deficiencies
Inspector: Kelly Nguyen
Inspector notes
On this day at around 12:30 pm, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection. LPA was met by staff Kester Orendain. LPA informed Orendain about the purpose of the visit. Administrator Juliet Pacaldo was not available and gave verbal permission for Jacob Pacaldo assistance administrator to sign the report. Administrator arrived later at 4:15pm to sign the report. The facility has an approved fire clearance for 11 non ambulatory and 3 bedridden residents. The facility has an approved hospice waiver for 4 residents. LPA observed 3 staff working during the visit. During the visit, LPA inspected the facility inside and out including but not limited to resident rooms, bathrooms, living/dining area, kitchen and backyard. Passageways were observed clear and free from obstruction. There was sufficient lighting. Smoke detectors are interconnected. First aid kit was observed to be complete . ***continuation on Lic 809 C*** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 At 3pm LPA reviewed 3 staff and 5 resident files. The following deficiencies were observed: · at around 12:51pm, LPA observed expired can goods/ food inside the cabinets and refrigerator. · at around 12:55pm, LPA observed unlock medication are left in the cabinet, and in refrigerator. LPA observed unlocked over the counter medication in resident’s room. · at around 1:40 pm, hot water measured at 130.3 degrees Fahrenheit residents shared bathroom. · Kitchen vent is in disrepair, and ceiling wall area observed crack. · LPA observed 3 Oxygen tanks without a stand and not secured · LPA observed 3 staff rooms in garage, separated by one door and two wall dividers are being alternated without a permit. · at around 3pm LPA reviews staff records 1 out of 3 do not have CPR and First Aid certificate on file · at around 3:30pm LPA reviews resident records 2 out of 5 residents do not have Admission Agreement and Physician Report on files Due to time limitation LPA will return and complete the annual inspection. A copy of this report provided via email.
ComplaintDecember 14, 2022· UnsubstantiatedNo deficiencies
Inspector: Kelly Nguyen
Unsubstantiated — CDSS investigated and did not find violations.
Inspector notes
LPA interviewed 5 residents 2 out of 3 are nonverbal. R7, R9, and R11 stated that they did not have any missing items, nor misplace of any of their personal belonging. R1, and R6 was nonverbal but can communicate with signs. R1 show thumbs up when asked if all the clothing belongs to R1. R1 was able to shake R1 heads indicated that it was R1 clothing and belonging that is in R1 closet. R1 put thumb down when asked if R1 wore things that does not belong to R1. LPA observed residents have their own separated closet / dresser. LPA conducted staff’s interview. 4 out of 4 stated that they have not witness or heard any residents’ complaints about their personal belonging are missing. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.
Other visitOctober 12, 2022Type A5 deficiencies
Inspector: Luisa Fontanilla
Inspector notes
On this day at around 9:35 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection. LPA was met by staff Kester Orendain. LPA informed Orendain about the purpose of the visit. Administrator Juliet Pacaldo arrived at around 10 am. The facility has an approved fire clearance for 11 non ambulatory and 3 bedridden residents. The facility has an approved hospice waiver for 4 residents. LPA observed 3 staff working during the visit. During the visit, LPA inspected the facility inside and out including but not limited to resident rooms, bathrooms, living/dining area, kitchen and backyard. Passageways were observed clear and free from obstruction. There was sufficient lighting. Fire extinguisher appeared to be full and with a tag date 1/16/2023. Smoke detectors are interconnected. There was sufficient supply of perishable and non perishable foods. At around 10:30 am, LPA reviewed 5 staff and 5 resident files. The following deficiencies were observed: at around 9:40 am, hot water measured at 143 degrees Fahrenheit in the kitchen. at around 9:46 am, LPA observed insulin in the refrigerator for a resident who passed away no nonskid mat in the bathroom floor wall in shower area with crack cranked toilet tank cover no carbon monoxide observed ***continuation on Lic 809 C*** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Staff and resident interviews were conducted at around 1:20 PM. Deficiencies were cited per Title 22 California Code of Regulations (refer to Lic 809D). Exit interview was conducted and Appeal Rights was provided to staff Kester Orendain who was authorized by Administrator to sign the report.
Every residential care facility for the elderly shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.
Based on observation, the licensee did not comply with the section cited above in not having carbon monoxide at the facility which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 07/31/2023 Plan of Correction 1 2 3 4 By POC date, Administrator will install carbon monoxide and submit photo proof to CCL.
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degre…
Based on observation, the licensee did not comply with the section cited above in having hot water at 143 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 07/31/2023 Plan of Correction 1 2 3 4 Administrator will adjust hot water within range within 24 hours and send CCL self-certification of completion.
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
Based on observation, facility failed to maintain resident common bathroom in good repair which poses/posed a potential health, safety or personal rights risk to persons in care. Toilet tank cover and wall in the shower area have cracks. POC Due Date: 08/18/2023 Plan of Correction 1 2 3 4 By POC date, Administrator will get the shower area fixed and send to CCL photo proof.
(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers.
Based on observation, the licensee did not comply with the section cited above in not having non skid mats in the bathroom which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/31/2023 Plan of Correction 1 2 3 4 By POC date, Administrator will replace all mats in the bathroom with non skid mats and submit photo proof to CCL.
Based on observation, the licensee did not comply with the section cited above in failing to dispose former resident's medications who passed away which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 07/31/2023 Plan of Correction 1 2 3 4 By POC date, Administrator will review section cited and submit to CCL certificate of understanding of deficiency cited.
Other visitSeptember 6, 2022No deficiencies
Inspector: Leslie Ibo
Inspector notes
On 10/12/2022 at 3:35PM, Licensing Program Analyst (LPA) L. Ibo conducted an unannounced case management visit due to incident report received on 10/11/2022, R1 inappropriately touched R2’s leg. LPA met with staff Mary Pacaldo, Administrative Assistant. LPA toured facility with S1, including but not limited to bedrooms, kitchen, bathroom, and common areas. LPA observed five (5) residents at the living room watching TV and other residents are in their own rooms. LPA interviewed R2; R2 stated that facility address the issue with R1. R2 was moved to different room although she doesn't feel like it is necessary to move her to a different room, R2 stated she understood the decision that was made. R2 stated that she feels safe at the facility. R2 stated that her and R1 were friends before the incident happened. Administrator stated that she called R1's doctor to get new assessment for R1. Based on interview this is R1's new behavior. No deficiencies cited during the visit. Exit interview conducted and a copy of this report provided.
Other visitJuly 21, 2022No deficiencies
Inspector: Leslie Ibo
Inspector notes
On 8/5/2022, Licensing Program Analyst (LPA) L. Ibo conducted a health and safety check as a result of department receiving a priority 1 complaint. LPA met with S3, LPA called Administrator Juliet Pacaldo. Tess Cruz (co-owner) arrived at the facility at around 11:40AM . Facility has census of 10. During the health and safety check, LPA toured the building inside and outside with S3, including but not limited to common areas, bathrooms, bedrooms and outdoor area. Facility had covid19 positive, last positive case 7/22/2022. LPA observed smoke detectors and carbon monoxide detector throughout facility. LPA observed sufficient food supplies for residents in care. LPA observed the following: · S7 is not fingerprint cleared and need fingerprint exemption clearance, S7 works at night shift · Fire door and resident door was blocked with hospital beds and wheelchair Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed Tess Cruz - Yee. Exit interview conducted and appeal rights copy of this report provided.
Other visitMay 5, 2022No deficiencies
Inspector: Daisy Panlilio
Inspector notes
On 09/06/22 at 2PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced case management visit and explained the purpose of the visit with staff (S1) and administrator who authorized S1 to act on her behalf and sign the reports. During the health and safety check, LPA observed a total of 3 staff wearing face masks and 11 residents at the facility. COVID screening was done by staff at the front entrance with no touch temperature probe, visitor's logs, hand sanitizers and additional face masks & gloves available on the screening station. LPA toured facility with S1, including but not limited to bedrooms, kitchen, bathroom, and common areas. LPA observed resident (R1) relaxing in the visitation area with 2 other residents. LPA observed R1 did not have any swollen eyes or any marks on his face. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date. No deficiencies cited during the health and safety check. Exit interview conducted and a copy of this report provided.
Other visitApril 21, 2022No deficiencies
Inspector: Catherine Lin
Inspector notes
Licensing Program Analysts (LPAs) C. Lin and L. Fici conducted a face to face Component III presentation on 04/21/2022 starting at 3:45pm. LPAs met with applicants Juliet Pacaldo and Tessa Cruz respectively. LPAs presented Component III power point and discussed the regulations embodied in the PowerPoint. LPAs observed the two participants gained knowledge about running and maintaining the facility in accordance with regulations. Exit interview conducted with applicants and a copy of the report provided.
Other visitApril 21, 2022No deficiencies
Inspector: Catherine Lin
Inspector notes
On 5/5/22 at 11:40 AM, Licensing Program Analysts (LPA) C. Lin arrived unannounced to conduct the 2nd Pre-licensing Required inspection for changing of ownership. LPA met with applicant, Tessa Cruz and explained the purpose of the visit. The facility currently has 9 residents. LPA toured facility, inspected deficiencies cited on 4/21/22, and confirmed that deficiencies have been corrected. Hot water temperature was 120 degrees F.. First Aide kit was observed to be purchased. Laundry detergent and cleaning supplies were observed locked inside the laundry room. Medication, knives, and scissors were observed locked in the kitchen. A bland new dresser was replaced. Alarm was observed to be installed on both doors exit to the backyard. Component III Orientation had been conducted previously with Juliet Pacaldo and Tessa Cruz by LPAs C. Lin and L. Fici on 4/21/22, therefore it's waived at this time. No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted with applicant and a copy of this report provided.
Federal summary
CMS Care CompareNot a CMS-certified facility
California RCFEs (residential care facilities for the elderly) are licensed by the state, not by CMS. CMS data only applies to skilled nursing facilities or to CCRCs that operate a licensed SNF wing.
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