Tlc Home Care V
RCFE
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 assistance with daily living activities such as bathing, dressing, meals, and medication management in a home-like setting. RCFEs are not hospitals or skilled nursing facilities — they do not provide round-the-clock medical care.
716 North Humboldt St · San Mateo, 94401
Quick facts
Quality snapshot
Updated April 25, 2026Compared to 214 California RCFE facilities of similar size, over the last 36 months.
Source: California Department of Social Services, Community Care Licensing Division. View raw inspection records →
Quality grade· click to show how this was calculated
Severity8thWeighted citations per bed
Repeats100thRepeat deficiencies as share of total
Frequency22thDeficiencies per inspection
Tick mark at 50% = peer median · higher percentile = better facility
Quality grade· click to show how this was calculated
Weighted citations per bed
Repeat deficiencies as share of total
Deficiencies per inspection
Tick mark at 50% = peer median · higher percentile = better facility
Tlc Home Care V scores C−. Better than 43% of comparable California RESIDENTIAL CARE ELDERLY facilities. Severity: bottom 8%. Repeats: top 0%. Frequency: 22th percentile.
Each metric is converted to a 0–100 percentile within the peer set (higher = better). The composite grade averages all four. Peer set: CA / rcfe_general / small beds (214 facilities).
Citation severity over time
↑ worseningWeighted severity score per month · 24 months
Weighted score (24mo)
92
Last citation
Mar 26
Finding distribution
19 total · 36 monthsScope × Severity (CMS A–L)
The rules that apply to this facility
California Title 22 requirements for this facility, with the specific regulation and a suggested question for each.Rules this facility has been cited for are shown first.
What health conditions can this facility legally accept or refuse?Cited Dec 202422 CCR §87612–87615
Restricted — allowed with physician order + care plan
- Supplemental oxygen
- Insulin and injectable medications
- Indwelling or intermittent catheters
- Colostomy / ileostomy
- Stage 1 and Stage 2 pressure injuries
- Wound care (non-complex)
- Incontinence
- Contractures
Prohibited — facility must refuse or discharge
- Stage 3 or Stage 4 pressure injuries
- Feeding tubes (PEG, NG, or J-tube)
- Tracheostomies
- Active MRSA or communicable infections requiring isolation
- 24-hour skilled nursing needs
- Total ADL dependence with inability to communicate needs
A hospice waiver (HSC §1569.73) can allow continued care for residents on hospice who would otherwise fall into a prohibited category.
Ask on tour: Ask whether your loved one's specific care needs are restricted or prohibited, and what the facility's process is if needs change after admission.
What training are all staff required to complete?22 CCR §87411
All direct-care staff must complete:
- 10 hours initial training within the first four weeks of employment.
- 4 hours annual in-service every year thereafter.
- Administrator certificate from a CDSS-approved program — 80 hours for first-time, 40 hours renewal every 2 years.
Ask on tour: Ask when the last staff training was completed and how it's tracked.
How many staff must be on duty overnight?22 CCR §87415
Based on 6 licensed beds:
One qualified staff member must be on call and physically on premises at all times overnight.
Violation pattern to watch for:A facility that documents a staff member as "on call" but with that person physically off-site — when the law requires on-premises presence — is in violation of this section.
Ask on tour: Ask the facility to walk you through their overnight staffing plan and confirm whether on-call staff are on premises or off-site.
What must this facility report to the state — and how fast?22 CCR §87211 / WIC §15630
- ImmediateElopement, fire, epidemic outbreak, or poisoningImmediately
- 2 hoursAbuse with serious bodily injury2-hour phone report + 2-hour written report — to the California Department of Social Services (CDSS), Adult Protective Services, and law enforcement
- 24 hrsAbuse without serious bodily injuryWithin 24 hours
- Next dayDeath of a residentPhone by next working day; written within 7 days
- Next dayInjury requiring medical treatment beyond first aidPhone by next working day; written within 7 days
- WrittenBankruptcy, foreclosure, eviction, or utility shutoff noticeWritten notice to CDSS and residents — $100/day penalty (max $2,000) for failure
Your enforcement lever:Incidents that aren't reported on time are themselves a separate violation. If you believe a reportable event wasn't filed, you can submit a complaint directly to the California Department of Social Services (CDSS).
How does CDSS enforce these rules?22 CCR §87755–87777 / HSC §1569.58
- 1Notice of DeficiencyWritten citation with a correction deadline. Facility must submit a Plan of Correction.
- 2Civil PenaltyStarts at $50/day for non-serious; $150/day for serious deficiencies — immediately, with no grace period. Repeats escalate to $150 first day + $50/day, then $1,000 first day + $100/day.
- 3Suspension of AdmissionsFacility cannot accept new residents until violations are corrected.
- 4Temporary Suspension or RevocationEmergency suspension for imminent danger; full revocation after administrative hearing.
- 5Exclusion OrderAdministrator and operator can be barred from all CDSS-licensed facilities — not just this one.
See how these rules have been applied to this specific facility:
View state inspection record and citationsState records
California Dept. of Social Services · Community Care Licensing- License number
- 415601175
- License type
- RESIDENTIAL CARE ELDERLY
- License status
- LICENSED
- License expires
- Not yet indexed
- Licensed beds
- 6
- Operator
- Mauricio, Lilia L
Inspections & citations
10
reports on file
19
total deficiencies
5
Type A (actual harm)
Other visitMarch 24, 2026Type A3 deficiencies
Plain-language summary
This was a routine facility inspection that found the home meets standards for safe housing, medication storage, food supplies, emergency preparedness, and staff qualifications. The inspector noted the facility has six private bedrooms with bathrooms, secure medication storage, appropriate water temperature, and adequate supplies and equipment. The facility was asked to submit some standard licensing paperwork by April 7, 2026, and there were some regulatory deficiencies noted that are detailed in the full report.
View full inspector notes
LPA Audrey Jeung toured facility and grounds, including detached storage building. There are 6 private bedrooms--all with private half or full bathrooms and all with direct exits to outside--staff room, shower room, living room, dining room, and kitchen. There are 2 beds in staff room for 3 staff. Clothes washer and dryer are located in one car garage. The backyard is level, fenced and mostly paved. Medications and toxins are secured in locked cabinets in kitchen and hallway, respectively. There are no accessible bodies of water or fire safety hazards observed. Carbon monoxide detector is tested and operable. Hot water temperature is tested at 118 degrees in client bathroom #4. Medications and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. First-aid kit is maintained and complete. Perishable and non-perishable fruits, vegetables and protein are maintained, as well as supplies of bed and bath linens and hygiene products. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Client files are reviewed, including Centrally Stored Medications Records. Joebelle Paymuo and Lilia Mauricio are certified RCFE administrators (x 1/28 & 4/26) that oversee facility operations. The following licensing forms are requested to be completed and submitted to CCLD BY 4/7/26: - Designation of Facility Responsibility (LIC308) - Personnel Report (LIC500) Proof of current liability insurance is given to LPA today. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Technical Advisory Note--1 page
Regulation
STORAGE SPACE & ACCESS ...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances... other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
Inspector finding
This requirement is not met. as paint is stored in unlocked storage shed in backyard. Licensee failed to ensure that toxics are inaccessible to clients, which poses an immediate health and safety risk to clients in care.
Regulation
INCIDENTAL MEDICAL CARE A record of centrally stored Rx medications for each resident shall be maintained and include... pharmacist, drug name, strength and quantity, dates filled, started & expiration, prescription number and instructions. This requirement is not met, as
Inspector finding
Centrally Stored Medication Records reflect incorrect dates filled, expiration dates, quantities, Rx numbers, and some meds are not recorded on CSMR. Licensee failed to maintain accurate CSMRs, which poses a potential health, safety or personal rights risk to clients in care.
Regulation
PERSONAL RIGHTS The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. This requirement is not met, as Personal Rights forms are incomplete or missing for
Inspector finding
3 out of 6 clients. Licensee failed to ensure that complete Personal Rights forms are maintained for all clients, which poses a potential health, safety or personal rights risk. Clients #3 and #4, have incomplete Personal Rights forms, and there is no Personal Rights form for client #5.
InspectionApril 22, 2025No deficiencies
Plain-language summary
A routine annual inspection on March 28, 2025 found deficiencies, which the facility corrected and reported by April 7, 2025. The state reviewed and confirmed that the corrections were properly made. The facility has been notified that these deficiencies have been resolved.
View full inspector notes
In response to deficiencies cited on 3/28/25 during annual visit and proof of corrections received on 4/7/25, LPA Jeung reviewed and confirmed corrections and obtained copies of documents. Acknowledgement of corrections is given to administrator--4 pages.
Other visitApril 22, 2025Type A1 deficiency
Plain-language summary
This was a regulatory meeting about the facility's approval to care for hospice residents. The facility admitted a third hospice resident in March 2025 without first obtaining the required state approval, violating the conditions of its existing authorization; the facility then requested an exception after the resident was already admitted. The state reminded the administrator that continuing to violate these conditions could result in loss of the facility's hospice care authorization.
View full inspector notes
LPA Jeung met with administrator to discuss conditions of facility's hospice waiver approved for TWO residents, as well as the Department's initial letter dated 1/14/25 of denial for an increase in the number of hospice residents that facility is allowed to serve. In March 2025, administrator submitted another request for an increase to the existing hospice waiver for two residents. On 4/4/25, this was denied again by the Department. Facility admitted a third hospice client on 3/22/25, despite the in Department's directive in the initial denial letter, which states that "the licensee may resubmit the hospice waiver request after six months of operation in substantial compliance of the regulations for reconsideration," and "for a prospective client to be admitted already receiving hospice care or requiring immediate hospice services, you must request and receive approval for a hospice exception prior to the resident being admitted." Two days after admitting client on hospice care, administrator submitted a letter requesting an exception for the hospice client. Administrator is reminded that failure to comply with conditions of approved hospice waiver for two could result in its revocation. Deficiency of the California Code of Regulations, Title 22 is cited on a following page.
Regulation
HOSPICE CARE OF TERMINALLY ILL The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill ... and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility when
Inspector finding
all of the following conditions are met: The licensee remains in substantial compliance with the requirements of this section, with the provisions of the RCFE Act (HSC 1569 et seq.), all other requirements of Chapter 8 of Title 22...CCR governing RCFEs, and with all terms and conditions of the waiver.
Other visitMarch 28, 2025Type A10 deficiencies
Plain-language summary
This was a routine inspection of the facility's physical premises, staffing, and records. The inspector found the home well-maintained with secure medication storage, appropriate temperatures, adequate food and supplies, and no safety hazards, though some licensing paperwork still needs to be submitted and a few regulatory requirements need to be corrected. The facility administrator's certification is current.
View full inspector notes
LPA Audrey Jeung toured facility and grounds, including detached storage building. There are 6 private bedrooms--all with private half or full bathrooms and all with direct exits to outside--staff room, shower room, living room, dining room, and kitchen. There are 3 beds in staff room. Clothes washer and dryer are located in one car garage. The backyard is level, fenced and mostly paved. Medications and toxins are secured in locked cabinets in kitchen and hallway, respectively. There are no accessible bodies of water or fire safety hazards observed. Carbon monoxide detector is tested and operable. Hot water temperature is tested at 106 degrees in client bathroom #3. Medications and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. First-aid kit is maintained and complete. Perishable and non-perishable fruits, vegetables and protein are maintained, as well as supplies of bed and bath linens and hygiene products. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Client files are reviewed. Centrally Stored Medications Records may be reviewed at a later date, due to time constraints. Joebelle Paymuo is a certified RCFE administrator (x 4/26) that oversees facility operations. The following licensing forms are requested to be completed and submitted to CCLD BY 4/11/25: - Personnel Report (LIC500) - Proof of current liability insurance Emergency Disaster Plan (revised 9 page LIC610-E signed and dated on page 9) is given to LPA today. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Technical Advisory Notes--3 pages.
Inspector finding
PERSONAL RIGHTS Residents in all RCFEs shall have ...the right...to be accorded dignity in their personal relationships with staff, residents, and other persons. Deficient Practice Statement 1 2 3 4 Based on observation, the licensee did not comply with the section cited above in 1 out of 6 client rooms, which poses an immediate health, safety or personal rights risk to persons in care. There is a video "nanny cam" in room #2 so staff can monitor client. Device also allows for audio monitoring…
Regulation
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations.
Inspector finding
Based on record review of clients, the licensee did not comply with the section cited above in 3 out of 6 client files reviewed, which poses a potential health, safety or personal rights risk to persons in care. - Appraisals are incomplete or not maintained for clients #3, #5, #6. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Completed and signed appraisals for clients 3, 5, 6 will be sent to CCLD BY DUE DATE.
Regulation
Staff training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before work…
Inspector finding
Based on absence of staff training records, the licensee did not comply with the section cited above, as there is no documentation that 3 out of 4 staff have received required 40 hours of initial training, which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Proof that all staff received required 40 hours of initial training will be sent to CCLD BY DUE DATE.
Regulation
PERSONAL RIGHTS The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record.
Inspector finding
Based on clients' record review, the licensee did not comply with the section cited above in 4 out of 6 client records reviewed, which poses a potential health, safety or personal rights risk to persons in care. Personal Rights froms are missing or incomplete for clients #1, #3, #4, #5. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Signed and completed Personal Rights forms for 4 clients will be submitted to CCLD BY DUE DATE
Regulation
POSTURAL SUPPORTS A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record.
Inspector finding
Based on clients' record review, the licensee did not comply with the section cited above, as there are no MD orders for half bed rails for client #2 and #3. This poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 MD orders for half bed rails for C2 and C3 will be sent to CCLD BY DUE DATE.
Regulation
HOSPICE CARE OF TERMINALLY ILL RESIDENTS A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record.
Inspector finding
Based on clients record review, the licensee did not comply with the section cited above, as there is no hospice care plan for client #5, which poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Hospice care plan for client #5 will be sent to CCLD BY DUE DATE
Regulation
(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.
Inspector finding
Based on observation, the licensee did not comply with the section cited above, as spray bottle of Mold and Mildew cleaner stored in common bath/shower room, accessible to clients. This poses an immediate health, safety or personal rights risk to persons in care. POC Due Date: 03/28/2025 Plan of Correction 1 2 3 4 Spray cleaner was removed to inaccessible storage area in LPA's presence. Deficiency corrected and cleared.
Regulation
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after e…
Inspector finding
Based on staff record review, the licensee did not comply with the section cited above in 3 out of 5 staff files reviewed, which poses a potential health, safety or personal rights risk to persons in care. - Health screenings and/or TB test results are not maintained for staff #2, #3, #4. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Health screenings and/or TB test results for staff 2, 3, 4 will be sent to CCLD BY DUE DATE.
Regulation
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivisi…
Inspector finding
Based on staff record review, the licensee did not comply with the section cited above, as there is no evidence that Staff #5 has received at least 20 hours of annual training. This poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Proof that staff #5 received at least 20 hours of annual training to be sent to CCLD BY DUE DATE
Regulation
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours o…
Inspector finding
Based on staff record review, the licensee did not comply with the section cited above, as there is no evidence that staff received medications training. This poses a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2025 Plan of Correction 1 2 3 4 Staff will received required medications training, and proof of correction to be sent to CCLD BY DUE DATE
ComplaintDecember 16, 2024· MixedType B2 deficiencies
Inspector: Audrey Jeung
Regulation
PERSONNEL REQUIREMENTS All services requiring specialized skills shall be performed by personnel qualified by training or experience in accordance with recognized professional standards. This requirement was not met, as non-medical staff provided wound care on C1 pressure ulcer on days when visiting
Inspector finding
LVNs and RNs did not visit client. Licensee failed to ensure that client received medical care from qualified personnel, which posed a potential health, safety or personal rights risk to clients in care.
Regulation
MANAGED INCONTINENCE In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for...ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
Inspector finding
This requirement was not met, as client #1 was observed on at least 4 occasions within a 30-day period to be in a soiled diaper. Licensee failed to ensure that client who needed incontinent care as clean and dry, which posed a potential health, safety or personal rights risk to clients in care.
Other visitDecember 16, 2024Type A3 deficiencies
Inspector: Audrey Jeung
Plain-language summary
During an investigation into a complaint, inspectors found that the facility did not meet California state regulations for care facilities. The report details specific violations on the following page. Families should review those cited violations for details about what was not in compliance.
View full inspector notes
During complaint investigation, deficiencies of the California Code of Regulations, Title 22 were observed and are cited on a following page.
Regulation
PROHIBITED HEALTH CONDITIONS Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a RCFE: Stage 3 and 4 pressure injuries. This requirement was not met, as former
Inspector finding
client was assessed to have stage III pressure injury on 3/27/24, which was being treated by home health. Licensee failed to relocate client to higher level of care or request exception from CCLD, which posed an immediate health, safety or personal rights risk to clients in care.
Regulation
ALLOWABLE HEALTH CONDITIONS & USE OF HOME HEALTH AGENCIES Incidental medical care may be provided to residents through a licensed HH agency provided...the licensee informs the HH agency of any duties the regulations prohibit facility staff from performing, and of any
Inspector finding
regulations that address the resident’s specific condition(s). This requirement was not met, as staff did not inform HH that they were not qualified to perform wound care nor that stage III pressure ulcers were prohibited, which posed a potential health, safety, or personal rights risk to clients in care.
Regulation
ALLOWABLE HEALTH CONDITIONS & USE OF HOME HEALTH AGENCIES The licensee & HH agency agree in writing on the responsibilities of the HH agency, & ...of the licensee in caring for the resident’s medical condition(s)... shall include day & evening contact information for the
Inspector finding
HH agency, & the method of communication between the agency & the facility, which may include ... logbook. This requirement was not met, as facility failed to maintain written record from HH of client's condition, which posed a potential health, safety or personal rights risk to clients in care.
Other visitMarch 6, 2024No deficiencies
Inspector: Audrey Jeung
Plain-language summary
This was a follow-up visit to confirm that the facility had completed required modifications from an earlier inspection. The facility was found to have met all requirements, including posting resident rights information and complaint procedures, making an internet-connected device available for residents, maintaining emergency keys for staff, and meeting physical plant standards for six non-ambulatory residents. The inspector recommended the facility be licensed, pending final approval.
View full inspector notes
LPA Jeung reviewed modifications made as per pre-licensing visit of 2/16/24. LPA observed the following: 1. Complaint information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints (PUB475), is posted prominently in area accessible to residents, representatives, and the public. (87468 Personal Rights) 2. Admission agreement, modifications and attachments, or notice of their availability, is conspicuously posted in a location accessible to public view in the facility. (87507 Admission Agreements) 3. An internet access device dedicated for resident use--such as a computer, smart phone, tablet, or other device that can support real-time interactive applications, equipped with videoconferencing technology, including microphone and camera functions--is acquired and maintained. (HSC 1569.319) 4. A spare set of keys--including all resident units, facility vehicles, all exit doors, all cabinets, cupboards or files that contain elements of the emergency and disaster plan, including, but not limited to, food supplies and protective shelter supplies--is available to staff on each shift for use during an emergency evacuation. (1569.695) Facility meets physical plant requirements for RCFE licensure for 6 non-ambulatory elderly clients over age 59 in 6 rooms. Fire clearance has been approved. Immediate licensure is recommended, pending final approval from Central Applications Unit.
Other visitFebruary 16, 2024No deficiencies
Inspector: Audrey Jeung
Plain-language summary
This is a licensure inspection for a new residential care facility with six private bedrooms that currently operates under a different license. The inspector found the facility's physical layout, security, and supplies adequate, but identified four items that must be completed before the license can be approved: posting complaint procedures and admission agreement information where residents can see them, providing a computer or tablet with video capability for resident use, and ensuring staff have access to all necessary keys during emergencies. The facility expects to address these items and receive its license.
View full inspector notes
Applicant Lilia Mauricio has applied for RCFE licensure for 6 non-ambulatory elderly clients over age 59 in 6 rooms. Fire clearance has been approved. Facility is currently licensed and operating under the name Apple Tree Home Care 2 #415600744, which is reflected on application (LIC200). There are 6 residents present; two residents receive hospice care. LPA Jeung toured facility and grounds of this one level facility. There are 6 private bedrooms--all with private half or full bathrooms and all with direct exits to outside--staff room, shower room, living room, dining room, and kitchen. There are 3 beds in staff room. Clothes washer and dryer are located in one car garage. The backyard is level, fenced and mostly paved, and supplies and paint are stored in detached storage shed, which is locked. Medications and toxins are secured in locked cabinets in kitchen and hallway, respectively. Food preparation and service items are present, as well as perishable and non-perishable fruits vegetables and protein. Supplies of bed and bath linens and hygiene products are observed. The following items are observed and must be addressed prior to licensure: 1. Complaint information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints (PUB475), shall be posted prominently in area accessible to residents, representatives, and the public. (87468 Personal Rights) 2. Admission agreement, modifications and attachments, or notice of their availability, must be conspicuously posted in a location accessible to public view in the facility. (87507 Admission Agreements) 3. An internet access device dedicated for resident use--such as a computer, smart phone, tablet, or other device that can support real-time interactive applications, equipped with videoconferencing technology, including microphone and camera functions--must be maintained. (HSC 1569.319) 4. A set of keys--including all resident units, facility vehicles, all exit doors, all cabinets, cupboards or files that contain elements of the emergency and disaster plan, including, but not limited to, food supplies and protective shelter supplies--must be available to staff on each shift for use during an evacuation. (1569.695) 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 to be contacted upon completion of the above 4 items. Revised Emergency Disaster Plan (LIC610E) is provided to LPA, which includes corrected utility shut off and fire extinguisher locations. Facility phone number is verified: 650/699-4010. Component III RCFE orientation is reviewed with licensee/administrator Lilia Mauricio and assistant administrator Joebelle Payumo. RCFE licensure is pending at this time.
Other visitJanuary 25, 2024No deficiencies
Inspector: Bethany Hunter
Plain-language summary
This was a change of ownership review conducted on January 25, 2024, for a six-bed residential care facility for elderly residents. The new owner and administrator were interviewed to confirm they understand California regulations covering facility operations, staffing, admissions, health restrictions, emergency preparedness, and complaint reporting. The applicant and administrator verified their identities and signed required documentation.
View full inspector notes
Facility Type: Residential Care Facility for the Elderly Application Type: Change of Ownership Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Lilia Mauricio Interview Method: Telephone interview On January 25, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readiness
ComplaintNovember 9, 2023No deficiencies
Inspector: Audrey Jeung
Plain-language summary
On November 9, 2023, state regulators met with the facility administrator to discuss non-compliance findings and provided resources to help improve operations. The specific violations from the underlying complaint investigation were reviewed with the administrator at that meeting. This was a follow-up meeting held after a complaint had been investigated.
View full inspector notes
On November 9, 2023, San Bruno Regional Office conducted a non-compliance conference meeting with Licensee/Administrator, Lilia Mauricio. Present in the meeting are Regional Manager, Vivien Helbling, Licensing Program Managers, Cara Smith, and April Cowan, Licensing Program Analysts, Grace Donato, Audrey Jeung and John Calandra, Long Term Care Ombudsman Robert Lewitzon are also present in this meeting. Licensee is provided the link below for resources and guidance to improve facility operations: https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers Report was reviewed with Licensee/Administrator, Lilia Mauricio and copies are 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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