Routine inspection·December 10, 2025

On this day, December 10, 2025, at 12:10 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Fekerte Hyesus, administrator (ADM), and informed the reason for visit. LPA toured the facility inside out with ADM. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has smoke and carbon monoxide detectors that were tested, and observed in operating condition during visit. Facility conducts disaster drills quarterly, and records showed last conducted September 18, 2025. Fire extinguishers were observed fully charge with tags showed serviced May 2, 2025. Hot water in the common bathroom was tested. LPA reviewed 4 staff and 5 residents files. Medications checked, and compared with records and doctor's orders. Facility does not handle residents' cash resources. LPA received copy of $3M liability insurance certificate on this day. ....continued on 809C Administrator to submit updated copies of the following by December 24, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) The following deficiencies were observed and cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalty. -at 12:16 pm, lighter and peeler in kitchen cabinets without lock. -at 12:25 pm, closet doors derailed and bio hazard container in one of the residents' rooms. -at 12:29 pm, broken drawer knobs in residents' room. -at 1:32 pm, hot water was at 137 degrees Fahrenheit. -at 1:33 pm, lavatory sink not properly draining. -at 2:00 pm, residents' (R1 and R2) half bed rails don't have doctor's orders on file. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.