Routine inspection·November 4, 2025

On this day, November 4, 2025, at 10:15 p.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual inspection. LPA met with House Manager Sally Espina and informed the reason for visit. LPA called and spoke over the phone with Haidie Bautista, administrator (ADM). ADM arrived at around 11:22 am. LPA started the inspection with house manager and continued with ADM. LPA inspected the 2 buildings (Bldg A and Bldg B) including but not limited to common areas, kitchens, dining areas, receiving room, library, bathrooms, shower rooms, porch, toilets, front, side and backyard. LPA selected for inspection 4 residents rooms in Bldg B and 5 in Buiding A. Fire extinguishers were observed fully charge with tags showed serviced May 12, 2025. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Hallways, common areas, yards and porch were observed free of obstructions. Facility has smoke and carbon monoxide detectors that were tested and observed in operating condition. Hot water temperature in one of the bathrooms in Bldg A was tested and measured at 105 degrees Fahrenheit . Facility conducts di saster drills at least every quarter and records showed last conducted October 6, 2025. .....continued on 809C LPA reviewed 5 residents and 5 staff files, and interviewed 3 residents. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 10:55 am, saline solution in night stand drawer without lock in one of the residents' rooms. -at 11:08 am, chest rub in the night stand in another residents' room. -at 11:17 am, nail polish remover in other residents' room. -at 11:29 am, shovels and rakes in Bldg B's yard. -at 3:00 pm, resident (R2) has After Visit Summary dated 6/2025 with change in dosage of 1 medication but facility still administers the previous dosage. Also on the list are new/added medications but the facility does not have those medications. LPA received updated copies of the following documents: 1. LIC308 Designation of Facility Responsibility 2. LIC610E Emergency Disaster Plan 4. $3M liability insurance certificate Administrator to submit a copy of updated LIC500 Personnel Report by November 18, 2025. Deficiencies are 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.. Deficiencies and plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.