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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209606
Report Date: 07/03/2026
Date Signed: 07/03/2026 06:13:52 PM

Document Has Been Signed on 07/03/2026 06:13 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:NORWICH ELDER CARE, LLC.FACILITY NUMBER:
107209606
ADMINISTRATOR/
DIRECTOR:		ARAGON, LEILANIFACILITY TYPE:
740
ADDRESS:2963 E NORWICH AVETELEPHONE:
(925) 922-4561
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 6CENSUS: 2DATE:
07/03/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator: ARAGON, LEILANITIME VISIT/
INSPECTION COMPLETED:
07:00 PM
NARRATIVE
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On 7/3/26 at 11:30 am. Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an initial complaint visit. LPA explained the purpose of the visit and was granted entry into the facility by Betty Brown. LPA asked Betty Brown to contact Administrator Leilani Aragon via telephone and let her know that the LPA was there to conduct a visit.

Administrator advised she was out of town and would not be able to respond to assist with the visit and stated that Glenn Bilog should arrive at the facility to conduct the visit.

LPA toured the facility and conducted and health and safety visit and observed the following deficiencies:


Betty Brown identified herself as the House Manager and was the only staff at the facility. LPA reviewed the facility roster and Guardian, and found Betty Brown is not associated or fingerprint cleared. Civil Penalty will be assessed

Staff Glenn Bilog, based on the facility roster is not cleared or associated to the facility. Civil penalty assessed.

Bedroom 2 per the facility sketch is missing a dresser.
Resident Room 4 and 5 are locked and inaccessible.
Resident Room 1 has a sign stating employees only. Glenn states he resides in bedroom 1.
Resident bathroom water temperature measured at 122.5 F.

Report continued on LIC 809-C.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Jacques Leffall
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2026
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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606
VISIT DATE: 07/03/2026
NARRATIVE
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LPA checked food supply. Food supply does not meet 2 day perishable and 7 day non perishable per Title 22.

The facility has two AC units. The temperature of the facility is 78 and 84 degrees F.

Medications were locked in a closet and inaccessible to residents. Once Staff arrived LPA was able to gain access to medications. Based on observation, 2 medications had a start date of 6/2/26. Centrally stored showed a start date of 6/2/26. Both Medication bottles showed a quantity of 15. Both bottles showed there were 4 pills left as of 7/3/26. Medication count not accurate. LPA took photos of medications.

An in-office visit will be conducted at a later date with Licensee.

Deficiencies are being cited and Immediate civil penalties issued on the attached 809-D and 421FC regarding lack of care and supervision, and persons not associated and cleared in facility.


A copy of this report with Appeal Rights was distributed to Glenn Bilog whose signature confirms receipt of this report.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Jacques Leffall
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/03/2026 06:13 PM - It Cannot Be Edited


Created By: Jacques Leffall On 07/03/2026 at 05:03 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/04/2026
Section Cited
CCR
87555(b)(26)

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General Food Service Requirements

(b) The following food service requirements shall apply:

(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises.
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Licensee had sufficient food delivered at facility on 7/3/26.
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Based on records reviewed and interviews conducted, there were not a sufficient supply of food for residents, which poses an immediate Health & Safety risk to the residents.
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Type A
07/04/2026
Section Cited
CCR87405(a)

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Administrator - Qualifications and Duties
(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.
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Licensee agrees to have staff fingerprinted and associated to facility.
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Based on records reviewed and interviews conducted, there was not an Administrator present to provide care and supervision, which poses an immediate Health & Safety risk to the residents.
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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.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Jacques Leffall
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/03/2026 06:13 PM - It Cannot Be Edited


Created By: Jacques Leffall On 07/03/2026 at 05:14 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/04/2026
Section Cited
CCR
87411(a)

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Personnel Requirements - General

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
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Licensee agrees to have staff fingerprinted and associated to facility.
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Based on records reviewed and interviews conducted, there was not staff present to provide care and supervision, which poses an immediate Health & Safety risk to the residents.
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Type A
07/04/2026
Section Cited
CCR87355(a)

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Criminal Record Clearance

(a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review.

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Licensee agrees to have all staff criminal record cleared and associated to facility.
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Based on records reviewed and interviews conducted, persons were providing care and supervision without a criminal record clearance and was not associated with facility, which poses an immediate Health & Safety risk to the residents.
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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.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Jacques Leffall
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/03/2026 06:13 PM - It Cannot Be Edited


Created By: Jacques Leffall On 07/03/2026 at 05:22 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/04/2026
Section Cited
CCR
87356(a)

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Criminal Record Exemption

(a) The Department shall notify a licensee to act immediately to terminate the employment of, remove from the facility or bar from entering the facility any person described in Sections 87356(a)(1) through (5) below while the Department considers granting or denying an exemption. Upon notification, the licensee shall comply with the notice.

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Licensee agrees to have all staff criminal record cleared and associated to facility.
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Based on records reviewed and interviews conducted, persons were providing care and supervision without a criminal record clearance and was not associated with facility, which poses an immediate Health & Safety risk to the residents
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Type A
07/04/2026
Section Cited
CCR87303(e)(2)

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(e) Water supplies and plumbing fixtures shall be maintained as follows:

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
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Licensee agrees to adjust water heater and test water to ensure it meets Title 22 regulations of a temperature ranging from 105-120 degrees F.
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Based on records reviewed and interviews conducted, water temperature was higher than the requirement of 122.5 degrees F in bathroom 1, which poses an immediate Health & Safety risk to the residents
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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.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Jacques Leffall
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2026


LIC809 (FAS) - (06/04)
Page: 6 of 9
Document Has Been Signed on 07/03/2026 06:13 PM - It Cannot Be Edited


Created By: Jacques Leffall On 07/03/2026 at 05:34 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/04/2026
Section Cited
CCR
87465(a)

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(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:

(4) The licensee shall assist residents with self-administered medications as needed.
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Licensee agrees to complete medication training and submit completion documents to CCLD by POC due date.
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Based on records reviewed and interviews conducted, 2 medications had a start date of 6/2/26. Centrally stored showed a start date of 6/2/26. Both Medication bottles showed a quantity of 15. Both bottles showed there were 4 pills left as of 7/3/26. Medication count not accurate which poses an immediate Health & Safety risk to the residents.Based on observation,
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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.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Jacques Leffall
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/03/2026 06:13 PM - It Cannot Be Edited


Created By: Jacques Leffall On 07/03/2026 at 05:45 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2026
Section Cited
CCR
87208(a)(7)(A)

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Plan of Operation

(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:
(7) Sketches, showing dimensions, of the following:
(A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents, other than for a temporary illness or recovery from surgery as specified in Sections 87606(d) and (e)
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Licensee agrees to have written Plan of Operation and submit to CCLD by POC due date.
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Based on records reviewed and interviews conducted, LPA was unable to observe a written Plan of Operation, which poses a potential Health & Safety risk to the residents.
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Type B
07/17/2026
Section Cited
CCR87506(a)

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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.

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Licensee agrees to submit all resident records to CCLD by POC due date.
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Based on records reviewed and interviews conducted, LPA was unable to observe a written resident records, which poses a potential Health & Safety risk to the residents.
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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.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Jacques Leffall
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/03/2026 06:13 PM - It Cannot Be Edited


Created By: Jacques Leffall On 07/03/2026 at 05:54 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NORWICH ELDER CARE, LLC.
FACILITY NUMBER: 107209606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2026
Section Cited
CCR
87307(3)(B)

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Personal Accommodations and Services

(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:

(B)Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers.

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Licensee agrees to provide a dresser with at least 2 drawers in resident bedroom 2, and submit photos to CCLD by POC due date.
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Based on records reviewed and interviews conducted, resident bedroom 3 did not contain a dresser with at least 2 drawers, which poses an immediate Health & Safety risk to the residents.
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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.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Jacques Leffall
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2026


LIC809 (FAS) - (06/04)
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