Routine inspection·April 30, 2026

On 4/30/2026 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with caregiver, Joana Dometita and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory. Administrator, Yanlin Huang later arrived at 11:45AM. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 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 70 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 105.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher purchased 3/20/2026. Emergency Disaster Plan was reviewed on 4/30/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/01/2025. At 10:40AM, LPA reviewed 6 residents records. At 12:00AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. report continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed unlocked/unsecured chemicals/cleaners under the sink in the kitchen and residents room as well as unsecured knives in the kitchen in the drying rack. (Dawn multi surface cleaner, Meyer's clean day multi surface) LPA observed caregivers room door open/unlocked with unsecured prescription medications as well as medications in a small container that were in the residents room/ next to the resident and had not been taken LPA advised Administrator to purchase more nonperishable foods Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 5/12/2026: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate 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.