Royal Colony View Place

On this day, August 6, 2025, at 1:20 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Ermi Macaraig, and informed the reason for visit. LPA called and spoke over the phone with Juliana Taburaza, administrator. LPA also met with other staff, Edwin Villarin. Administrator and Sheilha Muniz, business manager, arrived at around 2:20 pm. Facility has Infection Control Plan that was submitted on June 30, 2022. LPA toured the facility inside out with Ermi Macaraig. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Cleaning supplies were also locked. Facility has smoke and carbon monoxide detectors that were tested and observed in working condition. Hot water temperature in one of the common bathrooms was tested, and measured at 105.3 degrees Fahrenheit. Facility conducts fire and earthquake drills every month, and records showed l ast conducted July 1, 2025 and July 2, 2025 respectively. ........continued on 809C (page 2) 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 Page 2 LPA reviewed 4 staff and 5 residents files. Two residents were interviewed. Medications inspected and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Record. Resident's P&I checked and compared with last recorded balance. LPA observed the following: -at 1:50 pm, toilet in one of the common bathrooms leaking and wall tile chipped. -at 1:52 pm, greasy kitchen range and range hood. -at 1:54 pm, sliding door leading to the side yard very tight when being opened. -at 1:55 pm, metal pipes in the front yard. -at 5:20 pm, resident (R1) does not have doctor's order for 3 current medications. Administrator to submit the following updated/current documents by August 20, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $250.00 civil penalty is assessed for repeat violation of 87303(a). Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalty. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.

On this day, August 28, 2023, at 1:40 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Ermi Macaraig, and informed the reason for visit. LPA called and spoke over the phone with Juliana Taburaza, administrator. LPA also met with other staff, Edwin Villarin. Administrator arrived after about 2 hours. Facility has Infection Control Plan that was submitted on June 30, 2022. LPA toured the facility inside out with Ermi Macaraig. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. 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 functional. Hot water temperature in the common bathroom was tested, and measured at 112.8 degrees Fahrenheit. Facility conducts disaster drills every month, and records showed last conducted 8/01/24. LPA reviewed 3 staff and 5 residents files. Medications inspected and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Record. Resident's P&I checked and compared with last recorded balance. LPA observed the following: -at 1:50 pm, peelers in kitchen drawer without lock. -at 1:56 pm, missing baseboard in the kitchen area. -at 1:59 pm to 2:01 pm, Tylenol and razors in the resident's room. ........continued on 809C (page 2) 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 Page 2 -at 2:01 pm, medications in unlocked staff room. -at 2:04 pm, hair trimmer in another resident's room. -at 2:30 pm, shovel in the side yard. -at 6:15 pm, resident R1's dosage of 1 of the medications was crossed out and changed to 25 mg not by the prescribing doctor. The label on this medication showed 25 mg, 1 tablet everyday; however, the medications inside the bottle were cut into halves. The LIC622 for this medication showed 50 mg and no entry for quantity received by the facility. Administrator to submit the following updated/current documents by September 11, 2023: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof of corrections were discussed with the administrator. Administrator has to leave and have Ermi Macaraig sign and receive this report. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required/infection control inspection. LPA met with staff, Leticia Iroy and Dioscoro Iroy, and informed the purpose of LPA's visit. LPA called and spoke with Juliana Taburaza, administrator. Juliana Taburaza authorized Leticia Iroy to be with LPA during inspection and receive this report. LPA toured the facility inside and out with Leticia Iroy. LPA inspected the living room, dining area, kitchen, resident rooms, bathrooms, side yard and backyard. Medications are centrally stored in a locked area that is inaccessible to residents and refilled every 30 days. LPA observed food supplies for 2 days of perishables and 7 days of non-perishables, LPA observed COVID-19 signage all throughout the facility. Facility has hand sanitizer, masks and gloves available for visitors located inside near visitor's entrance door. Facility has visitor's log. Personal protective equipments (PPEs) inspected. Facility has a copy of approved LIC808 Mitigation Plan on file. Hot water temperature in one of the bathrooms was tested and measured at 115.5 degrees Fahrenheit. Facility has working smoke and carbon monoxide detectors. Fire extinguishers checked, observed fully charge with tags showed serviced October 19, 2020. Administrator to submit the following updated documents by August 4, 2021: 1. Proof of $3M liability insurance coverage 2, LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Copy of surety bond coverage ......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 LPA observed the following: 1. Exit door in the kitchen with no auditory signal and front door signal not working. 2. When asked, staff (S1) didn't know about screening of visitors prior to allowing entry. This was discussed by LPA at 10:35 am over the phone with Juliana Taburaza. 3. Insufficient supplies of N95 respirators and disposable gowns. 4. No record of staff's N95 respirator fit testing. 5. Trash bins in the bathrooms without lids. Deficiency is cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of correction by plan of correction due date, and any repeat violations within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with Juliana Taburaza over the phone in the presence of Leticia Iroy. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided to Leticia Iroy.

On this day, August 10, 2023, at 11:40 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Letecia Iroy, and informed the reason for visit. LPA called and spoke over the phone with Juliana Taburaza, administrator. LPA asked, and administrator stated she can not come to the facility, and authorized Letecia Iroy to be with LPA during inspection and sign and receive this report. Facility has Infection Control Plan that was submitted on June 30, 2022. LPA toured the facility inside out. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side and backyards. 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 functional. Hot water temperature in one of the bathrooms was tested, and measured at 113.8 degrees Fahrenheit. Facility conducts disaster drills quarterly, and records showed last conducted 7/02/23. LPA reviewed 4 staff and 5 residents files, and interviewed 1 staff and 2 residents. Medications checked, and compared with records and doctor's orders. LPA verified, and according to the administrator, facility handles only 2 residents' P&I. ...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 LPA observed the following: -at 12:18 pm, wood plank of the deck in the backyard with hole and some planks have signs of wearing out. -at 12:40 pm, LPA verified and S2 stated she administers medications; however, records showed no 8 hours required annual training for year 2022. S2 only has 4 hours dementia & no postural support/restricted health/hospice care training on file for year 2022. S3 who administers medications does not have 8 hours required annual training for year 2022 -at 1:30 and 1:45 pm, S3 and S4 has only 4 hours dementia & no postural support/restricted health/hospice care training on file for year 2022. -at 2:40 pm, residents' (R1, R2 & R3) LIC625 Appraisal/Needs and Services Plan on file are over a year old -at 4:00 pm, R3 has 2 medications but no doctor's order on file. Doctor's order on file for other 1 medication was 25 mg ( 1 tab at bedtime) bu t the medication on facility's hand is 50 mg (1 tab at bedtime). -P&1 cash and records of 2 residents (R3 and R4) are not in the facility. Administrator to submit the following updated/current documents by August 24, 2023: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator over the phone in the presence of Letecia Iroy. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.

Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection control annual inspection. LPA met with staff, Leticia Iroy, and informed the purpose of LPA's visit. LPA also met with other staff, Dioscoro Iroy and Rudy Walter Soriano. LPA called Juliana Taburaza, administrato; no answer. LPA also called and sent text message to Sheilha Muniz who arrived after about fourty minutes. Facility has LIC808 Mitigation Plan on file. LPA received copy of Infection Control Plan submitted by Juliana Taburaza on June 30, 2022. Staff were fit tested for N95 respirators on August 24, 2021. Sheilha Muniz stated she'll have the staff retested; copies of certificates to be submitted by August 24, 2022. LPA toured the facility inside out with Leticia Iroy. LPA inspected the living room, dining area, kitchen, bedrooms, bathrooms, laundry area, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. LPA observed screening station located near the entrance with visitor's log, hand sanitizer and thermometer. Hand sanitizer, surgical masks and disposable gloves are readily available at the screening station. Temperature and symptoms check are done at entry for visitors and staff. Visitors are checked for proof of vaccination, and antigen test kits are readily available. Residents and staff are screened for COVID-19 symptoms and temperature is checked and recorded daily. COVID-19 signages were observed posted all throughout the facility. Supplies of PPEs were checked. Hot water temperature at one of the common bathrooms was tested and measured at 115.7 degrees Fahrenheit. Fire extinguishers checked and observed fully charge with tags showed serviced October 21, 2021. . ......continued next page 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 2:41 pm, LPA observed Awesome all purpose degreaser and Comet in unlocked cabinet under the kitchen sink. LPA also observed two container of liquid laundry soap under the dining table. The following documents to be submitted August 15, 2021: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Proof of $3M liability insurance Deficiency is cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with Sheila Muniz. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.