Routine inspection·July 31, 2025

On 07/31/2025 at 10:33AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived to conduct an unannounced 1-Year Required inspection. LPA was greeted by Teresita Inocentes, Caregiver. LPA met with Caregiver Katherine Buenaflor, Caregiver, who spoke with Administrator Liezyl Ajos via telephone, and explained the purpose of the visit. The Administrator arrived at 11:01AM. Administrator currently holds a certificate (7019104740) that expires on 12/01/2025. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 113.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Continue on LIC809C Continued from LIC809 Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/11/2025. Emergency Disaster Plan was last posted on 06/30/2025. First aid kit was observed to be complete. Fire drill was last conducted on 11/11/2024. LPA reviewed three (3) staff records all three staff has FirstAid/CPR, S2 is missing health screening and S3 is not associated to facility. LPA reviewed all five (5) resident records they all were complete. LPA observed the following deficiencies during visit: At 11:24AM, LPA observed medication in an unlocked kitchen drawer At 11:29AM, LPA observed empty boxes, bed mattress, furniture, Hoyer lifts, luggage and wheel chairs in garage. At 11:30AM, LPA observed an exit door in the garage off the hinges, screw driver holding latch in place At 11:36AM, LPA observed a wooden shelf, walker, Hoyer lift and mattress and bed rails on top of a table in backyard At 12:26PM LPA observed during staff record review S2 missing health screening and S3 is not associated to the facility Continue on LIC809C Continued from LIC809C LPA requested the following documents to be submitted to CCLD by 08/08/2025. Resident Roster LIC 308 Designation of Administrative Responsibility Liability insurance. LIC 500 Personnel Report LIC 610E Emergency Disaster Plan. 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, LIC421BG, and this report provided