Routine inspection·August 28, 2025

On 08/28/2025 at 12:15 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Liza "Gigi" Elegado and explained the purpose of the visit. The facility’s fire clearance was approved for forty-nine (49) residents; all may be non-ambulatory. Hospice waiver approved for ten (10). Administrator Certificate# 7015304740 Expires 03/25/2026. LPA toured the facility with Liza including but not limited to two (2) 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 81 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 123, 124 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 medications, sharps and toxic are locked and inaccessible to residents in care. LPA reviewed 10 (ten) residents records. LPA reviewed eight (8) staff records and 7 of 8 have current first aid training and associated to the facility. LIC809-C Continued... LIC809-C (Page 2) THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 5:27pm LPA observed washing machines and bulky items located in a trailer and a broken mini refrigerator and table in parking lot At 5:30pm LPA observed window screen off window and dirty windows, and dirty dusty window blinds in the facility At 5:33pm LPA observed a ladder and garden tool outside Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/04/2025: 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 - Reviewed 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