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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004676
Report Date: 12/30/2025
Date Signed: 12/30/2025 06:15:42 PM

Document Has Been Signed on 12/30/2025 06:15 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SHERCON GUEST HOMESFACILITY NUMBER:
306004676
ADMINISTRATOR/
DIRECTOR:		CONSOLACION LUMAUIGFACILITY TYPE:
740
ADDRESS:13432 GALWAY STREETTELEPHONE:
(714) 815-9214
CITY:GARDEN GROVESTATE: CAZIP CODE:
92844
CAPACITY: 6CENSUS: 6DATE:
12/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Consolacion Lumauig - Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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On December 30, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit. LPA was greeted and granted entry after stating the purpose of the visit to Licensee/Administrator (LI) Consolacion Lumauig.

The facility is licensed to operate for six (6) non-ambulatory residents and has a hospice waiver for four (4) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, two (2) resident bathrooms, one (1) staff bedroom, one (1) staff bathroom, two living room areas, dining area, kitchen, an outdoor covered seating area, and detached two car garage.

LPA conducted a tour inside and outside of the physical plant with LI and requested copies of facility documents including: Resident Roster, Staff Roster, Staff Schedule, Resident Emergency Contact Forms, Physician’s Reports, Hospice/Home Health records, and Service Plans for residents.

During the visit, LPA Bentley observed a comfortable temperature of 75 degrees F was maintained in the facility. The smoke detectors and carbon monoxide detectors were operable. The facility has one (1) fire extinguisher that was charged, mounted, and purchased on December 30, 2025. First aid kit is maintained and contains all the necessary elements. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit.

CONTINUE TO LIC809-C....
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2025
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 4
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SHERCON GUEST HOMES
FACILITY NUMBER: 306004676
VISIT DATE: 12/30/2025
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Based on observations, interviews and record reviews LPA observed Physician’s Report for R1, indicating resident is Bedridden and the facility does not have an approved fire clearance for Bedridden residents. A deficiency is being cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. CIVIL PENALTY ASSESSED.

Due to to time constraints, LPA will address the following during the continuation annual visit:
· Fire clearance for Bedridden
· Medication and MAR
· Food Storage
· Staff Records
· Resident Records

LPA informed LI that subsequent visit will be conducted and additional deficiencies may be cited. LI stated they understood. An exit interview was conducted with Licensee/Administrator (LI) Consolacion Lumauig and a copy of this report, LIC809-D, and LIC421 were provided at the end of the visit.
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/30/2025 06:15 PM - It Cannot Be Edited


Created By: Eboni Bentley On 12/30/2025 at 05:30 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SHERCON GUEST HOMES
FACILITY NUMBER: 306004676

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87633(I)
(l) Residents receiving hospice care or prospective residents already receiving hospice care when accepted as residents who are bedridden, may reside in the facility provided the facility meets the requirements of Section 87606, Care of Bedridden Residents.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in one out of six residents in care, which poses an immediate health and safety risk to persons in care. LPA observed two Physician's reports for resident Resident #1 stating resident is bedridden. Facility does not currently have a fire clearance for bedridden residents.
POC Due Date: 12/31/2025
Plan of Correction
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Licensee stated they plan to transfer Bedridden resident to another licensed facility within 24 hours where a Bedridden room is available and submit proof to CCLD by 5pm on POC due date. Licensee stated additional plan to submit LIC 200 application and 850 form immediately requesting new fire clearance for Bedridden room at current facility. LPA observered Licensee notify resident's family of transfer and schedule appointment with Fire Marshall for 12/31/25 visit.
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.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2025


LIC809 (FAS) - (06/04)
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