Palm Tree Courtyard

At 2:30 pm on this day, September 26, 2025, a virtual meeting was called due to death of one of the licensees. The meeting was attended by the following: · Regional Manager Isaac Taggart · Licensing Program Manager Jeremy Fong · Licensing Program Manager Harpreet Humpal · Licensing Program Analyst Alicia Delmundo · Joseph Taburaza, licensee · Janelle Taburaza, co-administrator · Jonahlee Taburaza · Jasmine Taburaza · Joshua Taburaza The following were discussed: 1. Licensee’s commitment to continue the operation of the facility. 2. Permission to operate the facility under an Emergency Approval to Operate (EAO) for 60 days and documents required to be submitted to Regional Office for EAO. 3. Submission of application for license to Centralized Application Bureau within 20 days. A copy of this report provided via email to Janelle Taburaza.

On 3/03/2026 at 2:10 PM, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-Year Required inspection. LPA met with Cora Bugarin, DSP and explained the purpose of the visit. The Co-Administrator Rolando Carbonell arrived at 2:30 PM and Janell Taburaza arrived at 3:20 PM the Administrator currently holds a certificate (#6008264740) that expires 6/20/2026. LPA toured the facility inside out with Co-Administrator. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has smoke and carbon monoxide detectors that were tested and observed in operating condition. Hot water temperature in one of the bathrooms tested 105 degrees. Fire extinguishers were observed fully charge with tags showed serviced 09/16/25. Facility conducts fire and earthquake drills every quarter and records showed last conducted 2/02/26. First Aid kit was complete. ...continued on 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 CONTINUE FROM LIC809 Administrator to submit copies of the following updated/current documents by March 11, 2026: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate 5. Proof of Surety Bond coverage No deficiencies cited exit interview conducted. A copy of this report provided.

On this day, September 26, 2025, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a health and safety check as a result of the death of the licensee. LPA was granted entry by Corazon Bugarin, staff. LPA called and spoke over the phone with Sheilha Muniz, facility business manager (BM) and informed of LPA's presence at the facility and reason for visit. BM authorized Corazon Bugarin to be with LPA during inspection, and to sign and receive this report. LPA also met with other staff on duty, Josefino 'Budoy' Josue, Darnell Gabaca and Edgardo Gabaca. LPA toured facility including but not limited to the residents' bedrooms, bathrooms, kitchen, dining area, common areas, front, side and backyard. Facility has running water and electricity. Hot water temperature in one of the common bathrooms was tested and measured at 106.6 degrees Fahrenheit. One week of non-perishable and 2-day of perishable food supplies were available. There were 4 residents present, of which 1 was picked-up by a friend when LPA was conducting inspection. The other 8 residents were at the day programs. No deficiency cited on this date. Exit interview conducted and copy of this report provided.

On this day, 2/27/25, at 3:50 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on 2/20/25. LPA met with Sheilha Muniz, business office manager (BOM), and informed the reason for visit. LPA also met with Juliana Taburaza, administrator (ADM). LPA reviewed 5 residents and 5 staff files. Residents medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Residents' P&I were checked and compared with last recorded balance. No deficiency observed during today's inspection. Exit interview conducted and copy of this report provided.

Resident missed doses of medication LPA reviewed R1's MAR in 2019 and observed R1's medications were either given by staff or documented that R1 was on vacation. There were no missed doses of medications observed in R1's MAR in 2019. Residents medications were not refilled timely LPA reviewed email correspondence regarding medication refills and observed Administrator communicated with pharmacy or family for refill when R1 was low on medications. LPA reviewed R1's MAR in 2019 and did not observe any missed doses of medications in 2019. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted. A copy of this report provided.