Routine inspection·August 6, 2025

On this day, August 6, 2025, at 1:20 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Ermi Macaraig, and informed the reason for visit. LPA called and spoke over the phone with Juliana Taburaza, administrator. LPA also met with other staff, Edwin Villarin. Administrator and Sheilha Muniz, business manager, arrived at around 2:20 pm. Facility has Infection Control Plan that was submitted on June 30, 2022. LPA toured the facility inside out with Ermi Macaraig. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Cleaning supplies were also locked. Facility has smoke and carbon monoxide detectors that were tested and observed in working condition. Hot water temperature in one of the common bathrooms was tested, and measured at 105.3 degrees Fahrenheit. Facility conducts fire and earthquake drills every month, and records showed l ast conducted July 1, 2025 and July 2, 2025 respectively. ........continued on 809C (page 2) Page 2 LPA reviewed 4 staff and 5 residents files. Two residents were interviewed. Medications inspected and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Record. Resident's P&I checked and compared with last recorded balance. LPA observed the following: -at 1:50 pm, toilet in one of the common bathrooms leaking and wall tile chipped. -at 1:52 pm, greasy kitchen range and range hood. -at 1:54 pm, sliding door leading to the side yard very tight when being opened. -at 1:55 pm, metal pipes in the front yard. -at 5:20 pm, resident (R1) does not have doctor's order for 3 current medications. Administrator to submit the following updated/current documents by August 20, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $250.00 civil penalty is assessed for repeat violation of 87303(a). Failure to submit proof of corrections by plan of correction due dates may result in additional civil penalty. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.