Routine inspection·September 25, 2025

On 9/25/2025 at 10:45 am Licensing Program Analysts (LPA) K. Nguyen and P. Manalo arrived unannounced to conduct the 1-year annual requirement. LPA was greeted by care staff, Juan Pao Guintu and explained the purpose of the visit. LPAs spoke with Licensee Maria Linda Erolin and explained the purpose of the visit. Licensee arrived at 11:45 AM. LPAs with Licensee inspected the facility inside and out, including but not limited to resident rooms, bathrooms, living room, kitchen, dining area, and backyard. Hallways and passageways were observed free of obstruction. There was a sufficient supply of perishable and nonperishable foods. Towels, linen, and warm blankets were observed to be sufficient. Bathrooms and shower rooms have grab bars, a nonslip mat, and hygiene products. Smoke detectors and carbon monoxide were observed operational in the facility hallway. Hot water in the shared bathroom measured at 112.5°F. Fire extinguisher in the kitchen appears full and was last serviced on 07/07/2025. The first aid kit was observed to be complete. Emergency Drills was last conducted on 07/12/2025. LPA reviewed 3 resident files and 3 staff files. LPA reviewed the medication and log. Report continued to LIC809c... Continue from LIC809-C... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/02/2025: LIC 500 Personnel Report THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING THE VISIT: LPAs observed medication left on the table in the staff breakroom and in the residents' room. LPAs observed fruit flies in the dining area, on the countertop, and on the walls. LPAs observed expired food in the refrigerator and spoiled/molded fruits in the basket. LPAs conducted a file review. S2 does not have TB on record LPAs conducted a file review. S2 does not have CPR on record LPAs conducted residents' files; 3 out of 3 do not have an updated assessment on record LPAs observed foul odor coming in Room # 2, hoyer lift in the living room, two hoyer lift in the backyard, flies all around the facility, fridge and freezer not clean, etc. Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. A $250 civil penalty is assessed for repeat violation within 12 12-month period of section 87555(b) . Failure to submit proof of corrections by the plan of correction due date may result in additional civil penalties. Exit interview conducted. Appeal Rights, LIC421FC Civil penalty assessment, LIC9098 Proof of Correction form and copy of this report provided. Exit interview conducted. Appeal Rights and a copy of this report are provided.