Routine inspection·September 24, 2025

On 09/24/2025 at 4:00PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with caregiver, Elaine Francisco, and explained the purpose of the visit. The administrator, Administrator, Marivel Calambro, holds an administrator certificate #7012121740 expires 4/21/2026. Administrator arrived at 5:33pm. Fire clearance was approved for five (5) non-ambulatory and one (1) bedridden, and one (1) hospice resident. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms. One (1) bedroom occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 79 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 101.5 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. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/19/2025. Emergency Disaster Plan was last posted on 08/19/2025. First aid kit was observed to be complete. Fire drill was last conducted on 07/10/2025. Continued on LIC809. Continued from LIC809. Four staff records were reviewed. LPA also reviewed four (4) of five (5) resident records. One (1) resident was admitted into the facility today. LPA observed the following deficiencies: At 4:17pm, LPA observed knives, Pledge furniture polish, kitchen disinfectant, oven cleaner, and raid in unlocked cabinet underneath kitchen sink. At 4:23pm, LPA observed lock that was locked without key on door leading to garage (LPA has picture) At 4:26pm, LPA observed garage door that leads to back yard with chain lock that was locked (LPA has picture). At 4:28pm, LPA observed bedroom #2 does not have a chest of drawers, chair, and blinds are broken in window. At 4:36pm, LPA observed patio window does not have a screen. At 4:50pm, LPA observed during record reviewed the residents are missing the appraisal needs and services plans. At 5:40, LPA observed during record review staff has not completed the required 20 annual hours. Continued on LIC809C. Continued from LIC809C. LPA requested the following documents to be submitted to CCLD by 10/1/2025. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance An immediate civil penalty of $500.00 will be assessed on today's date for fire clearance (both locked doors). The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, 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 appeal rights, LIC421M, and this report provided.