<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202260
Report Date: 06/19/2026
Date Signed: 06/22/2026 04:25:39 PM

Document Has Been Signed on 06/22/2026 04:25 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:ARCHWAY OF CARMELFACILITY NUMBER:
275202260
ADMINISTRATOR/
DIRECTOR:		CYRIL TUPINOFACILITY TYPE:
740
ADDRESS:3262 TAYLOR ROADTELEPHONE:
(831) 269-4164
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY: 6CENSUS: 4DATE:
06/19/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:23 AM
MET WITH:staff Adrian RamachoTIME 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 06/19/2026, Licensing Program Analyst (LPA) V Gorban arrived unannounced at the facility to conduct a Required Annual Inspection. LPA met with lead Caregiver Maria Molina who invited Licensee Cyril Tupino to assist with the visit due to language barrier. LPA announced the purpose for the inspection to Licensee Cyril who assisted LPA conducting health and safety inside and outside facility tour .
LPA observed restricted pathways downstairs restricting pathway out through kitchen. During observation LPA notice missing carbon monoxide detectors. While touring the kitchen, LPA observed sufficient amount of perishable and non-perishable foodstuffs which were stored properly. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. A locked cabinet downstairs in the kitchen was observed to store resident medications, and medications appeared to be administered properly. The facility failed to provide for review requested emergency disaster plan and infection control plan. LPA reviewed resident and staff files. Residents files missing updated medical evaluation and reassessment. Staff files missing first aid/CPR and required annual training.
During outside walk LPA observed that an outdoor area which was accessible to residents contained a standing broken clothes dryer, and other miscellaneous appliances and items which could be hazardous to residents. During resident file review, it was observed that three out of four residents' files did not contain re assessment and medical evaluation. Three out of four residents diagnosed with dementia did not have records of appropriate reappraisals conducted within the last twelve months. See attached for deficiencies cited in accordance with California Code of Regulations Title 22, Division 6. Administrator was provided with a copy of the report and appeal rights. During Licensing inspection Licensee left facility and have not returned.
Exit interview conducted with facility staff, report signed and copy of this report with appeal right provided for facility records.
NAME OF LICENSING PROGRAM MANAGER: Shawna Doucette
NAME OF LICENSING PROGRAM ANALYST: Vadim Gorban
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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)
Page: 2 of 6
Document Has Been Signed on 06/22/2026 04:25 PM - It Cannot Be Edited


Created By: Vadim Gorban On 06/19/2026 at 01:36 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: ARCHWAY OF CARMEL
FACILITY NUMBER: 275202260

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and records review, the licensee did not comply with the section cited above, two out of three staff resent in the facility during the visit, not associated with the facility, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
1
2
3
4
Licensee will ensure staff leaves the facility.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Shawna Doucette
NAME OF LICENSING PROGRAM MANAGER:
Vadim Gorban
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2026


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 06/22/2026 04:25 PM - It Cannot Be Edited


Created By: Vadim Gorban On 06/19/2026 at 01:36 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: ARCHWAY OF CARMEL
FACILITY NUMBER: 275202260

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87466
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and records review, the licensee did not comply with the section cited above in three out of total 4 resident files reviewed missing required observations, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
Licensee will follow regulations by ensuring residents records are updated.
Type B
Section Cited
CCR
87705(c)(6)
Licensee who accept and retain residents with dementia shall be responsible for ensuring teh following:
Reaprasals to be completed ..... pursuat to section 87463
This requirement is not met as evidenced by: observation, interviews, and records reviewthree out of four resident records reviewed missing updated rearaisals which poses potential health and safety risk to persons in care.
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in three out of four residents records reviewed missing re appraisals, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
Licensee will ensure each dementia resident files contain updated reappraisals
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Shawna Doucette
NAME OF LICENSING PROGRAM MANAGER:
Vadim Gorban
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2026


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 06/22/2026 04:25 PM - It Cannot Be Edited


Created By: Vadim Gorban On 06/19/2026 at 01:36 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: ARCHWAY OF CARMEL
FACILITY NUMBER: 275202260

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.618(c)(4)
Other Provisions
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (4) Ensure that the facility is clean, safe, sanitary, and in good repair at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in two areas accesible to residents ( indoor and outdoor ) observed whith broken apliances, boxes, and other items that restrict safe access to residents, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
Licensee will ensure facility areas that accessible to residents are clutter free and does not poses potential health and safety risk to persons in care
Type B
Section Cited
CCR
87412(d)
Personnel Records
(d) The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above and placed facility administrator not approved by the CCL department, not associated with the facility, and does not follow licensing requirements, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
Licensee will ensure the facility has qualified administrator.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Shawna Doucette
NAME OF LICENSING PROGRAM MANAGER:
Vadim Gorban
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2026


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 06/22/2026 04:25 PM - It Cannot Be Edited


Created By: Vadim Gorban On 06/19/2026 at 01:36 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: ARCHWAY OF CARMEL
FACILITY NUMBER: 275202260

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87463(a)
Reappraisals
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in three out of four medical assessments reviewed missing or not updated, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
Licensee will ensure records available at the facility and updated by POC due date
Type B
Section Cited
HSC
1569.695(a)
Other Provisions
(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation the licensee did not comply with the section cited above and failed to provide emergency and disaster plan for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2026
Plan of Correction
1
2
3
4
Licensee will ensure emergency and disaster records available at the facility 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.
Shawna Doucette
NAME OF LICENSING PROGRAM MANAGER:
Vadim Gorban
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2026


LIC809 (FAS) - (06/04)
Page: 6 of 6