Routine inspection·October 8, 2025

On 10/08/2025 at 8:25 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Gary Santiago, and explained the purpose of the visit. Administrator, Maria Mendiola, came shortly after. Administrator certificate is current. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 bedrooms in total of which 4 bedrooms are occupied by the residents, and 1 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. 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 109.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid shower pans. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 09/19/2025. Emergency Disaster Plan was last posted on 07/16/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 08/29/2025. Liability Insurance is effective from 06/29/2025 to 06/29/2026. At 8:36 AM, LPA reviewed 4 residents records. At 9:13 AM, LPA reviewed 5 staff records and 5 of 5 have current first aid training and associated to the facility. At 10:26 AM, LPA reviewed P&I money. At 10:45 AM, LPA reviewed two samples of residents’ medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/22/2025 LIC 500 Personnel Report LIC 610E Emergency Disaster Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:37 AM, LPA observed Lysol Neutra Air unlocked in R4’s bathroom and Disinfectant Wipes in the garage. At 9:45 AM, LPA observed that S5 does not have a chest xray result from TB test. 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 with Administrator. Appeal Rights and a copy of this report provided.