Routine inspection·July 3, 2025

On 07/03/2025 at 11:45 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Richter "Rich" Quintong and explained the purpose of the visit. Rich phoned, Elizabeth "Beth" Quintong to inform. Beth arrived shortly after. The facility’s fire clearance was approved for capacity six (6) residents all non-ambulatory. Hospice waiver approved for one (1). Administrator Certificate #6033318740 expired 12/01/2024. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (6) total bedrooms which three (3) bedrooms are occupied by the residents and one (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 75 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 105 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 06/30/2025. Emergency Disaster Plan was last posted on 06/15/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 04/02/2025 and 04/07/2025. LPA reviewed three (3) residents records. LPA reviewed six (6) staff records and 6 of 6 have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 07/10/2025: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 309 Administrative Organization - Reviewed LIC 500 Personnel Report - Reviewed LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance Current Administrator’s Certificate - Reviewed The following deficiencies were observed (see LIC 809D) and 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.