Routine inspection·June 19, 2025

On 06/19/2025 at 9:00 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Marissa Rubio and explained the purpose of the visit. Administrator certificate is current. LPA toured facility 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. There are no bodies of water observed. 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 107.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 07/02/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 06/01/2025. At 9:50 AM, LPA reviewed 6 residents records. At 10:25 AM, LPA reviewed 4 staff records and 4 x 4 have current first aid training and associated to the facility. At 11:15 AM, LPA reviewed two sample of residents’ medications. At 11:45 AM, LPA reviewed resident's P&I money. 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 07/03/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:19 AM, LPA observed a knife by the kitchen sink unlocked. At 11:03 AM, LPA observed all residents' files incomplete. At 11:44 AM, record review revealed the facility does not have sufficient Surety Bond to cover P&I money. At 11:52 AM, LPA observed that S4 did not have TB test on file. 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.