019201665-4-17-2026-15-AS-ADEO-DT8TB3-20260417143429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 019201665
Report Date: 04/17/2026
Date Signed: 04/17/2026 02:34:44 PM

Document Has Been Signed on 04/17/2026 02:34 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME:	TRUE CARE SENIOR HOME		FACILITY NUMBER:	019201665
ADMINISTRATOR/ DIRECTOR:	ISON, LATANYA		FACILITY TYPE:	740
ADDRESS:	968 LESTER AVE		TELEPHONE:	(510) 962-1452
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 6		CENSUS: 6	DATE:	04/17/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Latanya Ison and Olajide Ogunfeyimi/Applicants		TIME VISIT/ INSPECTION COMPLETED:	03:35 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 this day, April 17, 2026, at 10:00 am, Licensing Program Analyst (LPA) Delmundo conducted an announced pre-licensing inspection. License application is for 6 total capacity, two (2) of which maybe non-ambulatory and one (1) bedridden. Fire clearance was granted on February 3, 2026. LPA met with applicants, Latanya Ison and Olajide Ogunfeyimi. Application is an initial/new application for license for this location. LPA toured the facility inside out with the applicants. There is no body of water. LPA inspected the living room, dining area, kitchen, bedrooms, bathroom, front, side and backyard. Central storage for medications was observed in the office with lock. Applicants stated the sharps and cleaning supplies will be kept and stored also in the office. LPA reminded that if the sharps will be transferred to the drawers in the kitchen, the drawers shall have locks. Bedrooms were observed appropriately furnished with adequate lighting and drawers. The facility has sufficient towels and linens. Supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed adequate for residents' use. There’s 7 days supplies of non-perishables. Facility has working land line phone and internet service. Fire extinguisher was observed fully charge and when verified, applicants stated it was purchased this year. LPA discussed for it to be serviced every year. Carbon monoxide and smoke detectors were tested and observed in operating condition on this day. First aid kit was checked and observed complete with manual. ....continued on 809C

NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Alicia Delmundo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026

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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: TRUE CARE SENIOR HOME	FACILITY NUMBER: 019201665
	VISIT DATE: 04/17/2026

NARRATIVE

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LPA observed the following:
-no auditory signals on all exit doors.
-at 10:30 am, one of the residents' rooms (shared room) can only be accessed through another resident's room (private room).
-at 10.40 am, bedroom designated for bedridden resident does not have ramp and this bedroom's exit door is about a foot high from the backyard ground.
-at 10:50 am, uneven ground surface of area in the backyard for use as activity area for residents.
-at 10:53 am, soiled/dusty third storage in the backyard.
-at 10:55 am, rolled soiled wood and metal pipe in the backyard.
-no call button for residents' use.
-facility sketch not consistent with the orientation/actual physical plant lay out, cabinets inside the facility and storages in the backyard not indicated.
-no Ombudsman poster.

Applicants to do the following and to submit pictures, documents and/or proof of purchase by May 1, 2026:
1. Install auditory signals on exit doors.
2. Put soil and sand to level the backyard activity area.
3. Discard the third storage.
4. Discard the rolled wood and metal pipe.
5. Purchase call buttons.
6. Install ramp and decrease the capacity to 5 and submit the following:
7. LIC200 for 5 total capacity.
8. Corrected/updated sketches showing the following:
-Exit doors and windows
-Dimensions and use of each room
-Number of resident(s) in each bedroom
-Utility shut off locations
-locations of closets
-Outside sketch showing the building, perimeter fence, walkway, ramp, storage and utility shut off locations.

NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Alicia Delmundo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026

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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: TRUE CARE SENIOR HOME	FACILITY NUMBER: 019201665
	VISIT DATE: 04/17/2026

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9. Post Ombudsman poster.

Upon receipt of LIC200 and updated sketches, LPA to submit to Centralized Applications Bureau analyst who in turn will submit a new request for fire safety inspection.

LPA to do re-inspection once the new fire clearance is granted and corrections to the deficiencies are completed.

LPA discussed obtaining $3M liability insurance upon granting of license and admission of first resident and submitting a copy of the insurance certificate to LPA.

Exit interview conducted and copy of this report provided to applicants.

NAME OF LICENSING PROGRAM MANAGER: Bennett Fong
NAME OF LICENSING PROGRAM ANALYST: Alicia Delmundo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026

LIC809 (FAS) - (06/04)

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