Routine inspection·January 8, 2026

On 01/08/2026 at 8:55 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Elizabeth Alba, and explained the purpose of the visit. Administrator arrived shortly after but had to leave during the visit. Administrator gave 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 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 70 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 106 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 and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 01/06/2026. First kit was observed to be complete. Emergency disaster drill was last conducted on 12/16/2025. At 9:45 AM, LPA reviewed 5 residents records. At 10:22 AM, LPA reviewed 4 staff records and 3 of 4 have current first aid training and 4 of 4 associated to the facility. At 11:45 AM, LPA reviewed a sample of resident’s 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 01/16/2026: LIC 500 Personnel Report THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:01 AM, LPA observed Clorox Disinfecting Wet Mopping Cloths, scissors in in master bathroom, Clorox wipes under the kitchen sink, and the sharps cabinet in the kitchen unlocked. 9:05 AM, LPA observed Freestyle Lancets, A&D Ointment, Hydrophilic Wound Dressing, Thick It, and Milk of Magnesia unlocked. At 9:10 AM, LPA observed the door alarm in room #3 not working. At 9:12 AM, LPA observed a plant, wheelchair, and a bedside table in front of the sliding door in Room #6. At 9:28 AM, LPA observed rotten cauliflower, wilted cabbage, wilted bean sprouts, and eggs left in the garage. At 9:45 AM, record review revealed that S2 does not have a first aid certification. At 10:30 AM, LPA observed that R1 has a full bed rail and is not on hospice. At 11:45 AM, LPA observed that the Medication Administration Record (MAR) is incomplete. At 12:00 PM, LPA observed that R5 is unable to perform their own glucose test. 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. Appeal Rights, LIC421FC, and a copy of this report provided.