Routine inspection·October 24, 2025

On 10/24/2025 at 10:30 AM, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with the Administrator Michelle Cajucom and explained the purpose of the visit. Administrator certificate is # is 7002125740 with an expiration date of 12/7/2025. The facility’s fire clearance was approved for all six (6) non-ambulatory and two (2) hospice waiver. The facility is vendorized by the Regional Center of the East Bay (RCEB). LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms. Three (3) 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 was measured at 114 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. Centrally stored medications were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were tested and observed in operating condition. Fire extinguisher was last serviced on 12/10/2024. First aid kit was observed to be complete. Fire drill was last conducted on 9/9/2025. At 11:00 AM, LPA reviewed P&I money and log with Cajucom. The facility has sufficient surety bond to cover cash being handled. At 11:10 AM, LPA reviewed medications and Medication Administration Record (MAR) with Cajucom. At 11:50 AM, LPA reviewed 4 staff records and 4 client records. All 4 staff are fingerprint cleared and associated to the facility. They have current first aid and CPR training. ******continuation on Lic 809C****** Updated copies of the following documents were requested from the facility and are to be submitted to CCL by 10/30/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Infection Control Plan Registration/Insurance/Driver's License Surety Bond There is no deficiency noted for this visit. A copy of this report was provided to Cajucom.