Routine inspection·March 17, 2026

On 03/17/2026 at 11:40 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Wenna Bernal, and explained the purpose of the visit. Administrator certificate is current. Administrator gave verbal authorization 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 total bedrooms of 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. 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 100.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/14/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/09/2026. At 12:42 PM, LPA reviewed 6 residents records. At 1:17 PM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. At 3:00 PM, LPA reviewed two samples of residents’ medications. Continue to LIC809-C... Continued from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/25/2026: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 12:00 PM, LPA observed unlocked eyedrops in the linen closet and unlocked cleaning chemicals in the laundry machine room. At 12:25 PM, LPA observed over ripped bananas. At 12:25 PM, LPA observed that the facility does not have enough perishable food. At 12:30 PM, LPA observed that the hot water temperature is measured at 100.7 degrees Fahrenheit. At 1:30 PM, LPA observed that 6 of 6 residents do not have a complete Appraisal Needs and Services Plan (LIC625). At 2:00 PM, LPA observed that R3 and R5 are missing one of their medications in the facility, there is a missing doctor’s order for R5’s medications, and R5’s supplement dosage does not match the doctor’s order. 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 Bernal. Appeal Rights and a copy of this report provided.