Routine inspection·March 20, 2025

On 03/20/2025 at 9:45 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Anabelle Mendoza and explained the purpose of the visit. Anabelle phoned Administrator/Licensee, Victoria "Vickie" Lingbanan to inform. Vickie arrived to the facility approximately 1 hour later. Facility’s fire clearance was approved for capacity twenty-two (22) residents in which all may be non-ambulatory. Hospice waiver approved for five (5) residents. Administrator certificate #6006625740 expires 11/25/2025. LPA toured the facility with Vickie including but not limited to five (5) residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 73 degrees F downstairs and 75 degrees F upstairs. The hot water temperature in a sample of residents’ shared bathroom were measured at 102.4, 102, 103.3 degrees Fahrenheit. Administrator raised hot water temperature and now water is measuring at 115 degree 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 medications, sharps and toxic are locked and inaccessible to residents in care. LIC809-C LIC809-C Continued (Page 2) LPA reviewed seven (7) residents records. LPA reviewed four (4) staff records and 4 of 4 have current first aid training and associated to the facility. 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. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 04/03/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance Current Administrator’s Certificate - Reviewed Exit interview conducted. Appeal Rights and a copy of this report provided.