Routine inspection·July 31, 2025

On 9/19/2024 at 10:00 AM, Licensing Program Analysts (LPA) Yasamin Brown arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Nancy Tayag and explained the purpose of the visit. The administrator currently holds a certificate (#7035689740) that expires on 12/18/2025. The facility’s fire clearance was approved for six (6) residents, six (6) may be non-ambulatory. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of six (6 ) total bedrooms which five (5) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. 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 9/19/2024. First aid kit was observed to be complete. Continue to LIC809C. Continued from LIC809. LPA reviewed five (5) resident records and three (3) staff records. LPA reviewed a sample of resident’s medications. The following forms will be updated and submitted to CCLD by 8/7/2025: LIC610D: Emergency disaster plan Updated Facility Sketch The following deficiencies were observed: At 10:40 am, LPA observed R1, R2, R3, R4 and R5 had half bed rails but no written physicians order. At 10:51 am, LPA observed R1, R2, R3, and R4 did not have updated medical assessments completed. At 11:30 am, LPA observed missing CPR training from 0/3 staff members. At 11:35 am, LPA observed missing First Aid training from 0/3 staff members. At 11:40 am, LPA observed missing 20 hr training from 0/3 staff members. At 11:45 am, LPA observed that there wasn't an updated quarterly fire drill conducted. A technical violation was issued during the visit. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report provided.