Routine inspection·December 16, 2025

On 12/16/2025 at 11:15 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Alex Juntilla, and explained the purpose of the visit. The facility’s fire clearance was approved for all six (6) may be non-ambulatory and two (2) hospice waiver. LPA toured facility with Administrator inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 4 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors were in operating condition during visit. Fire extinguisher was last serviced on 12/4/2025. Emergency Disaster Plan was last reviewed on 4/1/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 9/1/2025. Continued on LIC809-C. Continued from LIC809. LPA reviewed four (4) staff and six (6) resident records. LPA reviewed a sample of medication. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 12/23/2025: LIC610D: Emergency disaster plan LIC500: (Personnel Record) LIC 308 Designation of Administrative Responsibility The following deficiencies were observed: At 12:15 pm, LPA observed R2, R3, R4, and R5 had missing Appraisal needs and services plan. At 12:30 pm, LPA observed missing first aid training from S1, S2, and S3. * Civil Penalty in the amount of $250 is being assessed on today's date for repeat violation* Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Alex Juntilla. A copy of the appeal rights, LIC421FC and this report provided.