502701585-5-28-2025-27-AS-ELIM-DH4SKC-20250528135630

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 502701585
Report Date: 05/28/2025
Date Signed: 05/28/2025 01:56:58 PM

Document Has Been Signed on 05/28/2025 01:56 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:	LORILIE'S HOME LLC		FACILITY NUMBER:	502701585
ADMINISTRATOR/ DIRECTOR:	MANALOTO, JONATHAN		FACILITY TYPE:	740
ADDRESS:	3909 FELTON WAY		TELEPHONE:	(209) 422-6505
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY: 6		CENSUS: 0	DATE:	05/28/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Applicant Jonathan Manaloto		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

NARRATIVE
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	On 05/28/2025 at 10 AM, Licensing Program Analysts (LPA) Triel Ellen Lindstrom and Renee Campbell arrived at the facility for an announced pre-licensing inspection. The LPAs were greeted by Jonathan Manaloto, the Administrator and Licensee applicant listed on the LIC200, and his wife Lorilie Rodillas. A brief interview and a tour of the facility followed. The applicant accompanied the LPAs on the tour. This facility is a three bedroom residential house that has been cleared for six non-ambulatory residents by the City of Modesto Regional Fire Authority on 01/06/2025. BEDROOMS 1, 2, and 3: The LPAs toured Bedrooms 1, 2, and 3, per the LIC999 Facility Sketch (floor plan). The three bedrooms are located behind a door off the hallway at the front of the house. Each bedroom is cleared per the fire inspection for an occupancy of two residents. Each bedroom contained the required furniture in good repair, including two single beds, two dressers, two night stands with two lamps, and two chairs. The floors, walls, windows, and closets are clean and in good repair. Bedroom 3 has a private bathroom and a walk-in closet. There is a smoke detector in each bedroom. All of the smoke detectors in the house are interconnected. BATHROOM 1 and 2: The LPAs toured Bathrooms 1 and 2. Bathroom 1 is located in the hallway near the bedrooms. Bathroom 2 is located in Bedroom 3. Both bathrooms were clean and odor-free. The hot water temperature in the Bathroom 1 sink is 115 degrees F. There are sturdy grab bars in both showers and near the toilets, and non-slip flooring in the showers. Each bathroom contains cabinets for hygiene products that can be locked if needed to secure hygiene products if they pose a risk to residents.

NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Ellen Lindstrom
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LORILIE'S HOME LLC	FACILITY NUMBER: 502701585
	VISIT DATE: 05/28/2025

NARRATIVE

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HALLWAY: A smoke detector and carbon monoxide alarm were observed in the hallway. Both were tested and found to be functioning. A closet containing linen and paper supplies was also found in the hallway. The thermostat is located in the hallway and was set at 75 degrees F.

LIVING ROOM: The required informational posters about filing a complaint and contact information for the ombudsman were observed in the hallway leading to the living room. The living room contains two easy chairs and a couch. There was a cabinet that contains activity material. A sliding glass door leads from the living room to the backyard.

BACKYARD: The LPAs observed a shaded, covered back patio immediately outside the sliding glass doors that contains a large table with chairs. The yard is manicured and weeded, and the trees, bushes, and grass are trimmed. The fence that encloses the backyard is sturdy, intact, and in good repair. The side gate is side-closing and self-latching. The concrete walkways were free of obstructions. There is a locked shed that contains personal items belonging to staff and there is an open air green house structure with potted plants.

KITCHEN: The counters, cabinets, sink, floor, and appliances are clean, operable, odor-free and pest-free. There is enough plateware and cutlery for all residents. The freezer temperature is 0 Fahrenheit (F) degrees and the refrigerator is 40 F degrees. Sharp objects are stored in a locked drawer and toxic chemicals are not stored in the kitchen

DINING ROOM: The dining room was clean and the dining table contained enough seats for all residents. There is a fireplace that has a screen barrier in front of it. A staff workspace is located along one wall of the dining room, which includes a desk and locked cabinets for resident and staff files and resident medication. A new fire extinguisher hangs on the wall, which was inspected by Jorgensen Company of Modesto on 12/20/2024.

CENTRAL MEDICATION STORAGE: The LPAs observed the area that will be used for central medication storage. This area is located in the cabinets above the staff desk in the dining room. There are binders for medication administration records for each resident, as well as individual containers for each residents medication.

NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Ellen Lindstrom
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

LIC809 (FAS) - (06/04)

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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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LORILIE'S HOME LLC	FACILITY NUMBER: 502701585
	VISIT DATE: 05/28/2025

NARRATIVE

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STAFF ROOM:The LPAs toured the staff room, which is located off the dining room. It contains beds and furniture for live-in staff.

LAUNDRY ROOM: The LPAs toured the laundry room. The laundry room contains a washer and dryer and cabinets that are locked. The door that leads from the laundry room to the garage has a keyed lock.

GARAGE: The LPAs toured the garage. The garage contained an additional refrigerator/freezer that contains food for staff, yard maintenance equipment, and crates for the on-site dogs. The garage has a door that leads to the backyard that will remain locked.

PETS: The Licensee has pets on-site. At the time of this tour, the LPAs observed parakeets and guinea pigs in separate cages in the backyard. The animal enclosures are odor-free and well-maintained. The Licensee has three small dogs that will live on-site. The Licensee stated that the dogs live outside in the backyard and stay the night in crates in the garage; they do not come in the house. The LPAs discussed the importance of the Licensee disclosing the presence of pets to prospective residents.

As a result of this inspection, the facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6. Pre-Licensing is complete and this facility has no deficiencies.

An exit interview was conducted with Applicant Manaloto, to whom a copy of this LIC809 report was provided. Their signature below confirms receipt of this document.

NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Ellen Lindstrom
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

LIC809 (FAS) - (06/04)

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