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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004676
Report Date: 10/01/2026
Date Signed: 10/01/2026 05:13:07 PM

Document Has Been Signed on 10/01/2026 05:13 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SHERCON GUEST HOMESFACILITY NUMBER:
306004676
ADMINISTRATOR/
DIRECTOR:		CONSOLACION LUMAUIGFACILITY TYPE:
740
ADDRESS:13432 GALWAY STREETTELEPHONE:
(714) 815-9214
CITY:GARDEN GROVESTATE: CAZIP CODE:
92844
CAPACITY: 6CENSUS: 4DATE:
10/01/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Connie LumauigTIME VISIT/
INSPECTION COMPLETED:
05:26 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced Annual Required inspection. Upon arrival, LPA Tea was greeted and granted entry into the facility by Administrator (AD) Consolacion Lumauig. LPA explained the purpose of the visit. The facility is licensed for six non-ambulatory residents and has a hospice waiver for four residents. The facility currently has a census of four residents, none are receiving hospice services at the time of today's visit.

LPA Tea reviewed four resident records and one staff record. Discrepancies were identified during the records review. LPA observed forms in resident records that were not signed and/or were not the appropriate forms. Additionally, the staff record reviewed did not contain documentation demonstrating completion of required annual staff training. The Administrator Certificate expires on August 8, 2027.

LPA Tea, accompanied by AD Lumauig, conducted a tour of the facility. LPA inspected the physical plant, food service areas, and first aid supplies. The facility consists of five resident bedrooms, one staff room, three bathrooms, a laundry room, living room, dining room, staff office area, kitchen, and attached garage.

Smoke and carbon monoxide detectors located in the common areas and resident bedrooms were tested and observed to be operational. Resident bedrooms contained the required furniture, bed linens, and adequate closet and drawer space. Resident bathrooms were inspected. Toilets and faucets were operational, grab bars were secure, and the shower areas were free of mold and mildew. The hot water temperature measured 119.7 degrees Fahrenheit. Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked at the time of the visit.

(Annual Inspection continued on LIC809C)

Lourdes Montoya
Michael Tea
DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2026
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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Document Has Been Signed on 10/01/2026 05:13 PM - It Cannot Be Edited


Created By: Michael Tea On 10/01/2026 at 04:27 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SHERCON GUEST HOMES
FACILITY NUMBER: 306004676

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's review of staff records. Staff did not complete the required annual training. This poses as a health and safety risk to residents in care.
POC Due Date: 10/22/2026
Plan of Correction
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Facility will complete required staff annual training and submit proof to LPA by POC due date
Type B
Section Cited
HSC
1569.695(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's review of facility records. There were no documentation of quarterly disaster drills. This poses as a potential health and safety risk to residents in care.
POC Due Date: 10/22/2026
Plan of Correction
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Facility will complete disaster drills quaterly and will submit proof to LPA by POC due date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Michael Tea
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2026


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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SHERCON GUEST HOMES
FACILITY NUMBER: 306004676
VISIT DATE: 10/01/2026
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Common areas were clean and free of hazards, and passageways and doorways were free of obstructions. The first aid kit contained required supplies, including dressings, bandages, tweezers, a thermometer, and scissors. LPA inspected the kitchen and observed an adequate supply of perishable and nonperishable food. Kitchen appliances were operational at the time of the visit. Sharp objects were secured in a locked kitchen drawer. Toxic substances were secured and inaccessible to residents in locked cabinets located in the laundry room and underneath the kitchen sink. Fire extinguishers located throughout the facility were observed to be fully charged. During the records review, the facility was unable to provide documentation demonstrating that required quarterly disaster drills had been conducted.

LPA toured the exterior grounds and observed an exit gate located on the left side of the facility that was self-latching and operational. The backyard contained a shaded patio area available for resident use. Emergency food and water supplies were observed and stored in the garage. Activities are provided based on residents' individual preferences, abilities, and health conditions. The facility provides activities such as light exercise. During today's visit, LPA observed residents walking throughout the facility and watching television.

LPA reviewed medication storage and administration. Medications were stored in a locked cabinet located in the staff office area and were inaccessible to residents. Medications reviewed were being administered in accordance with physicians' orders.

LPA interviewed residents regarding the quality of care and services provided and spoke with staff regarding care and supervision provided to residents.

Based on observations and records reviewed during today's visit, deficiencies are being cited pursuant to Title 22, Division 6, Chapter 8 of the California Code of Regulations. See LIC 809-D for deficiencies cited.

An exit interview was conducted with Administrator Consolacion Lumauig. This report was reviewed with AD Lumauig. Copies of the LIC 809, LIC 809-C, LIC 858, LIC 859, LIC 809-D, and Appeal Rights were reviewed and provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
LIC809 (FAS) - (06/04)
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