Routine inspection·August 19, 2025

On 08/19/2025 at 10:05 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Annabelle Marinas, and explained the purpose of the visit. Administrator was not available to come for today’s visit, and gave authorization for staff to sign the report. LPA toured the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 bedrooms, of which 4 bedrooms are occupied by the residents, and 1 bedroom is occupied by staff. 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 117 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Centrally stored medication and 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 03/10/2025. Emergency Disaster Plan was last posted on 05/26/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 06/24/2025. At 10:23 AM, LPA reviewed 4 residents records. At 11:29 AM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. At 1:30 PM, LPA reviewed 4 of 4 residents’ medications. Continue to LIC809-C... Continue to LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 09/03/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Infection Control Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:05 AM, LPA observed the residents’ pantry locked. At 10:40 AM, LPA observed an insufficient amount of canned goods or nonperishable food. At 10:47 AM, LPA observed Chlorox Lysol Wipes, Medline Sterile Saline Wound Spray, Oatey Clear Cement, and etc. accessible to residents in care. At 10:53 AM, LPA observed eggs outside the fridge in the kitchen. Staff stated that the egg had been there for two days, and they would transfer the eggs from the fridge in the garage to the kitchen shelf. LPA observed half a banana rotten inside the kitchen drawer. At 12:00 PM, LPA observed a chair blocking the exit door in Bedroom #3 At 10:23 AM, LPA did not observe an updated LIC602A (Physician’s Report) for R1, R2, and R4. LPA did not observe an updated LIC625 (Appraisal Needs and Services Plan) for R1, R2, and R3. LPA did not observe the correct LIC613C (Personal Rights) for R2, R3, and R4. At 2:02 PM, record review revealed that R2 and R4 do not have a half rail bed order on file. 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 and a copy of this report provided.