306002921-3-25-2026-22-AS-BLOZ-DSHVNH-20260325163509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002921
Report Date: 03/25/2026
Date Signed: 03/25/2026 04:35:46 PM

Document Has Been Signed on 03/25/2026 04:35 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:	SAINT NINO MANOR		FACILITY NUMBER:	306002921
ADMINISTRATOR/ DIRECTOR:	DIVINE A. OLEGARIO		FACILITY TYPE:	735
ADDRESS:	4110 W. ASH AVENUE		TELEPHONE:	(714) 879-2269
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92833
CAPACITY: 6		CENSUS: 4	DATE:	03/25/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Licensees Divine and Rolando Olegario		TIME VISIT/ INSPECTION COMPLETED:	05:00 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 March 25, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Licensees Divine and Rolando Olegario were notified via telephone and later arrived to assist with the inspection. LPA observed that Rolando Olegario has a valid Administrator certificate which expires on May 2, 2028. The facility is an Adult Residential Facility (ARF) licensed for six ambulatory clients. The facility is a single story home with three client bedrooms, one of which is shared, one client bathroom, one staff bed room, a living room, a dining room, a kitchen, a staff office, and an attached two car garage. LPA, accompanied by the Licensees, conducted a tour of the interior portion of the facility. On today's visit, LPA observed four clients in care and one staff present. LPA observed clients returning from their Day Program and relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all three client bedrooms and they were observed to be free of any hazards. LPA observed the client bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA tested the smoke detector in each client bedroom and they were observed to be operational. LPA observed client beds had clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the shared client bathroom and observed it to be clean. The client bathroom was equipped with grab bars and a nonskid floor mat. The faucet and toilet was operational. The hot water temperature measured 105.3 degrees Fahrenheit. LPA observed that the staff bedroom and the staff office are kept locked and inaccessible to clients in care. LPA observed that the facility has a two day perishable and a seven day non-perishable food supply on hand. CONTINUED ON 809-C

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SAINT NINO MANOR	FACILITY NUMBER: 306002921
	VISIT DATE: 03/25/2026

NARRATIVE

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LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed knives and sharps to be stored in a locked closet by the kitchen. LPA observed the facility has a three day emergency food and water supply stored in the closet by the kitchen. A fire extinguisher is located in the kitchen and it was observed to be charged and serviced as of February 4, 2026. LPA tested the carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 5, 2025. The centrally stored medication is kept in a locked closet by the kitchen. LPA observed a first aid kit is also stored in the locked closet and it was observed to have all the required components. LPA observed a fireplace in the living room and it was observed to be adequately fenced and not in operation at time of visit. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to clients in care. LPA observed the garage to be used for storage and laundry. LPA observed the facility has its chemicals and toxins stored in the locked garage.

LPA, accompanied by the Licensees, conducted a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for client use. The perimeter gates of the facility are self-latching and can be open in an evacuation. There is a pool located in the backyard which is adequately fenced and kept locked for client safety.

LPA reviewed all four client files. All the required documentation were present and current in the client files reviewed. LPA reviewed all four clients' medication and medication administration records. LPA reviewed all four clients' Personal and Incidental expense monies (P&I) records. LPA reviewed five staff files. All staff are background cleared and associated to the facility.

Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensees Divine and Rolando Olegario. A copy of the report was provided at time of visit.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

LIC809 (FAS) - (06/04)

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