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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701167
Report Date: 12/12/2025
Date Signed: 12/12/2025 04:31:34 PM

Document Has Been Signed on 12/12/2025 04:31 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:YOUNG AT HEART RCFE NO.1, INC.FACILITY NUMBER:
342701167
ADMINISTRATOR/
DIRECTOR:		MOLINYAWE, GLENDAFACILITY TYPE:
740
ADDRESS:9027 COLOMBARD WAYTELEPHONE:
(916) 689-7378
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 6CENSUS: 6DATE:
12/12/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Glenda MolinyaweTIME VISIT/
INSPECTION COMPLETED:
04:58 PM
NARRATIVE
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On 11/26/2025, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to this facility to conduct a case management visit for deficiencies observed on 12/12/2025. LPA met with Glenda Molinyawe and explained the purpose of this visit.

LPA observed there was a hoyer lift and two mobility devices obstructing one of the sliding door exits, located by bedroom 6. LPA observed the top and bottom bed rails were lifted in R2's bed and they
S2 stated they do not know if R2 has a physicians order for a full bed rail. Additionally, mobility devices were not available near R2 and R3 during this visit whom are non- ambulatory and require a mobility device. Moreover, R2 and S2 stated that R2 has only been in bed since move in date on 11/25/25, they are changed and recieve bed baths while in bed as there is no hoyer lift available that has the capacity to assists R2. LPA observed there is one hoyer lift at the facility. S2 stated the hoyer at the facility cannot sustain 300 plus pounds and the licensee is in contact with Master Care to get an safe and appropriate hoyer lift for R2.

Resident records for R2 where not available for review by LPA during this visit. S2 stated R2 moved in on 11/25/25 and the licensee has the record with them. S2 stated they will e-mail R2's records to LPA by 12/15/25.

As a result of this case management visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with (S2) and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.
NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Cynthia Tamayo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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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Document Has Been Signed on 12/12/2025 04:31 PM - It Cannot Be Edited


Created By: Cynthia Tamayo On 12/12/2025 at 03:33 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: YOUNG AT HEART RCFE NO.1, INC.
FACILITY NUMBER: 342701167

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2025
Section Cited
CCR
87307(d)(6)

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87307 Personal Accommodations and Services (d) ... safety provisions... (6) All outdoor and indoor passageways ... shall be kept free of obstruction, this requirement was not met as evidence by LPA observations and interviews in which
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LPA observed staff cleated the exit passageway during this visit. By 12/15/25, Facility staff will submit a statement of review and understanding of 87307(d)(6) and submit a plan to train al staff on fire clearance regulations.
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LPA observed there was a hoyer lift and two mobility devices an exit passageway, this poses an immediate/potential health and safety risk for residents in care
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Type A
12/13/2025
Section Cited
CCR87468.1(a)

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87468.1 Personal Rights of Residents in All Facilities (a) Residents ... personal rights: (2) To be accorded safe, healthful and comfortable accommodations ... and equipment. This requirement was not met as evidence by LPA observations, interviews, and record review in which it was
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By POC due date, the facility will submit a plan for ensuring mobility devices are accessible to residents who require mobility devices, only residents with physicians orders for full bed rails can have full bed rails, and to ensure inaccessibility of mobility devices does not act as restraint for residents
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 the top and bottom bed rails were lifted in R2's bed and there was no physicians order available for review during this visit. Additionally, mobility devices were not available near R2 and R3 during this visit whom are non- ambulatory and require a mobility device. Moreover, R2 and S2 stated that R2 has only been in bed since move in date on 11/25/25. S2 stated there s not currently a hoyer that can up to 300 plus pounds at the facility the licensee is in contact with Master Care to get an safe and appropriate hoyer lift for R2. this poses an immediate/potential health and safety risk for residents in care
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 and resident personal rights are not being violated.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Tamayo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/12/2025 04:31 PM - It Cannot Be Edited


Created By: Cynthia Tamayo On 12/12/2025 at 03:47 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: YOUNG AT HEART RCFE NO.1, INC.
FACILITY NUMBER: 342701167

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2025
Section Cited
CCR
87506(a)

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87506 Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. this requirement
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By POC due date: Licensee will email LPA resident record for R1 by 12/15/25 and ensure current record is maintained for each resident in the facility from 12/15/25.
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 was not met as evidence by LPA observation, interview, and record reviews due to resident records for R2 where not readily available for review during this visit which poses an immediate/potential health and safety risk for residents in care including admission agreement, LIC 602, care plan, pre-appraisal, etc. this poses an immediate/potential health and safety risk for residents in care
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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.
Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Tamayo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2025


LIC809 (FAS) - (06/04)
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