Routine inspection·March 18, 2026

On 03/18/2026 at 10:30 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Mary Ann Garcia, and explained the purpose of the visit. Co-Administrator, Warlita Rivac, arrived shortly after. Administrator certificate is current. Ksai Liang gave authorization for Warlita Rivac to sign the report. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA 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 115.2 degrees Fahrenheit. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 03/18/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/12/2026. At 11:00 AM, LPA reviewed 2 residents records. At 11:21AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and 2 of 3 associated to the facility. At 2:00 PM, LPA reviewed samples of residents’ medications. Continue to LIC809-C... Continued from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/26/2026: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Infection Control Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:49 AM, LPAs observed unlocked cleaning chemicals such as Lysol Spray, Clorox, medications, scissors, etc. all around the facility. At 11:00 AM, LPAs observed spoiled bell peppers, bread, juices, and other food items with best by dates from 2025. At 11:40 AM, LPA observed that S2 and S3 have incomplete records in the facility. At 11:50 AM, LPAs observed that S3 is not associated with the facility. At 12:41 PM, LPAs observed the freezer in the garage in disrepair, the old patio cushions in trash bags, and one of the rooms without a bed. At 1:42 PM, LPAs observed that R1 does not have doctor's order for their medications and does not have 2 of their medications in the facility. LPAs observed that R2 does not have a doctor's order for all the medications. Continue to LIC809-C... Continued from LIC809-C... At 1:54 PM, record review revealed that there is no liability insurance in the facility file. At 1:58 PM, record review revealed that 2 of 2 residents don't have the Appraisal Needs and Services Plan (LIC625). At 2:00 PM, record review revealed that 2 of 2 residents don’t have a doctor’s order for half bed rail. 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 Co-Administrator. Appeal Rights and a copy of this report provided.