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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600201
Report Date: 12/01/2025
Date Signed: 12/01/2025 03:22:55 PM

Document Has Been Signed on 12/01/2025 03:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:REYES GUEST HOME NAVARONNE IIFACILITY NUMBER:
075600201
ADMINISTRATOR/
DIRECTOR:		REYES, FFACILITY TYPE:
740
ADDRESS:810 NAVARONNE WAYTELEPHONE:
(925) 691-6037
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY: 6CENSUS: 5DATE:
12/01/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 AM
MET WITH:Lorna Rodrigo, Caregiver TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 12/1/2025 at 12:15 pm Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct an annual required inspection. LPA met with Lorna Rodrigo and explained the purpose of the visit. Lorna phoned Administrator (AD) Lucas Argueza.

The Administrator currently holds a certificate (#6074709740) that expires on 1/30/2027. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. All indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for residents is maintained at 73 degrees Fahrenheit.

LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. Smoke detectors and carbon monoxide combination were in operating condition during visit. First aid kit was observed to be complete. LPA reviewed four (4) staff and five (5) resident records. LPA reviewed a sample of medication.

Continued on LIC809-C.





NAME OF LICENSING PROGRAM MANAGER: Harpreet Humpal
NAME OF LICENSING PROGRAM ANALYST: Yasamin Brown
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: REYES GUEST HOME NAVARONNE II
FACILITY NUMBER: 075600201
VISIT DATE: 12/01/2025
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(Continued from LIC809...)

The following forms will be updated and submitted to CCLD by 12/8/2025:

  • LIC610D: Emergency disaster plan
  • LIC500: (Personnel Record)

The following deficiencies were observed:
  • At 12:45 pm, LPA observed missing CPR training from 0/4 staff members.
  • At 1:00 pm, LPA observed missing first aid training from 0/4 staff members.
  • At 1:05 pm, LPA observed that S1 was not associated to the facility.
  • At 1:15 pm, LPA observed the water temperate was measured at 150.1 degrees Fahrenheit.
  • At 2:00 pm, LPA observed that there wasn't an updated quarterly fire drill conducted.

*An immediate $500.00 civil penalty will be assessed on today's date for association.*

Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Administrator Lucas Argueza gave authorization for caregiver Lorna Rodrigo to sign todays report.



Exit interview conducted with Lorna Rodrigo. A copy of the appeal rights and this report provided.













NAME OF LICENSING PROGRAM MANAGER: Harpreet Humpal
NAME OF LICENSING PROGRAM ANALYST: Yasamin Brown
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 12/01/2025 03:22 PM - It Cannot Be Edited


Created By: Yasamin Brown On 12/01/2025 at 02:27 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: REYES GUEST HOME NAVARONNE II
FACILITY NUMBER: 075600201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(3)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation the licensee did not comply with the section cited above as water temperature observed at 150.1 degrees Fahrenheit which poses an immediate health and safety risk to persons in care.
POC Due Date: 12/02/2025
Plan of Correction
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By POC date, the administrator agrees to submit weekly temperate checks and send a copy to CCLD. Administrator agrees to submit proof of maintenance/staff adjusting the water temperate between 105 and 120 degrees Fahrenheit and submit to CCLD.
Type A
Section Cited
CCR
87355(e)(3)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the Licensee did not comply with the section cited above in not having S1 associated to the facility, which poses an immediate health and safety risk to person in care.
POC Due Date: 12/02/2025
Plan of Correction
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4
By POC date, Administrator agreed to send LIC9182 and S1 identification to CCLD to be associated.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Harpreet Humpal
NAME OF LICENSING PROGRAM MANAGER:
Yasamin Brown
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 12/01/2025 03:22 PM - It Cannot Be Edited


Created By: Yasamin Brown On 12/01/2025 at 02:27 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: REYES GUEST HOME NAVARONNE II
FACILITY NUMBER: 075600201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.618(c)(3)
Other Provisions
(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 staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that out of the 4 staff members, none of the staff members on duty had proof of CPR training in which poses an immediate health and safety risk to persons in care.
POC Due Date: 12/08/2025
Plan of Correction
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By POC date, The Administrator agrees to schedule at least one staff member to receive CPR training and submit documentation of scheduled training to CCLD. Administrator agreed to also send the completion of the training on 12/8/2025.
Type B
Section Cited
CCR
87411(c)(1)
Personnel Requirements - General
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 0 out of 4 staff members did not have first aid certification on file which poses an immediate health and safety risk to persons in care.
POC Due Date: 12/08/2025
Plan of Correction
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By POC date, The Administrator agrees to schedule all staff members to receive first aid training and submit documentation of scheduled training to CCLD by POC date. Administrator agreed to also send the completion of the training on 12/8/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Harpreet Humpal
NAME OF LICENSING PROGRAM MANAGER:
Yasamin Brown
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 12/01/2025 03:22 PM - It Cannot Be Edited


Created By: Yasamin Brown On 12/01/2025 at 02:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: REYES GUEST HOME NAVARONNE II
FACILITY NUMBER: 075600201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.695(c)


This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on file review, the licensee did not comply with the section cited above in that the facility did not have a current fire drill since the last drill was conducted 6/15/2025 which poses a potential health and safety rights risk to persons in care.
POC Due Date: 12/08/2025
Plan of Correction
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Administrator has agreed to conduct emergency disaster fire drills quarterly and will send a copy of the most recent drill to CCLD by POC date. Administrator has agreed to conduct a fire drill in the facility by 12/8/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Harpreet Humpal
NAME OF LICENSING PROGRAM MANAGER:
Yasamin Brown
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2025


LIC809 (FAS) - (06/04)
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