Routine inspection·September 17, 2025

On 09/17/2025 at 9:10 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Satvinder Kaur, and explained the purpose of the visit. Administrator, Mary Sunderraj, gave authorization on the phone for staff to sign the report. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 bedrooms in total of which 4 bedrooms are occupied by the residents, 1 bedroom is occupied by staff, and one office. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the residents shared bathroom was measured at 107.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors in operating condition during visit. Fire extinguisher was last serviced on 11/06/2024. Emergency Disaster Plan was last posted on 09/03/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 07/11/2025. At 10:27 AM, LPA reviewed 6 residents records. At 10:58 AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. At 12:30 PM, LPA reviewed 4 samples of residents’ medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/03/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Infection Control Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:15 AM, LPA observed both bathrooms not cleaned and R5's room with a strong urine odor. At 9:17 PM, LPA observed broken patio furniture in the backyard. At 9:29 AM, LPA observed Lysol wipes in the office, disinfectant spray in the hallway, and Tide Pods in resident's room unlocked and accessible to residents in care. At 9:45 AM, LPA observed unlocked medications such as eyedrops, Miralax, Gummies, Tums, Levothyroxine, Ointment, etc., in all the residents’ room. At 10:30 AM, first aid kit was not observed. Continue to LIC809-C... Continue from LIC809-C... At 12:30 PM, an interview with staff revealed that R3 had an incident and was not reported to licensing. At 1:06 PM, observation and interview revealed that the facility does not have a carbon monoxide detector. At 1:16 PM, a record review showed that the facility did not have updated training for S3 and S4 on file. At 1:41 PM, interview with staff stated that R1 does not have a doctor's order for the half bedrail. At 1:45 PM, S4’s personnel file was not at the facility. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.