Routine inspection·September 22, 2025

On 09/24/25 at 08:30AM, Licensing Program Analyst (LPA) Andrew Christy and Licensing Program Manager (LPM) Harpreet Humpal arrived unannounced to do an annual inspection. LPA and LPM meet with caregiver Gualip Hermenelinda and explained the purpose of the visit. Administrator Mary Malekamu arrived at 9:15AM. Facility currently houses four (4) residents. LPA inspected the facility inside out. Facility is kept at a comfortable temperature at 73.0 degrees Fahrenheit. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Hot water measured to 119.6 degrees Fahrenheit. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Outdoor activity space was observed furnished with tables, chairs and shade. Fire extinguishers were observed fully charge and tags showed serviced 09/22/2025. At 10:30AM, LPA reviewed four (4) residents records and five (5) staff records. Emergency Disaster Plan was last updated 09/22/2025. Continued on LIC809C..... Continued from LIC809..... The following deficiencies were found during the inspection: At 8:30AM, LPA and LPM experienced difficulty in communication with staff members due to a language barrier. Interviews with all four residents confirmed they face similar issues when communicating needs. During inspection, most resident rooms were found to not have screens on the windows, with one resident's window being broken itself found at 10:25AM. At 8:45AM, the first room inspected was found to have a damaged electrical outlet and a window that will not shut. The kitchen was found to have a broken cabinet and the freezer door on the fridge was completely stuck and unable to move without two people attempting. As well, all resident doors shut by themselves in a quick and forceful manner. At 8:55AM, one storage closet, which is unlocked, had a can of paint primer easily accessible. At 9:30AM, the first bathroom inspected had a bottle of Pepto Bismal in an unlocked cabinet. At 10:25AM, one of the pathways in the backyard was found to be blocked with various pieces of furniture and debris/junk. At 10:30AM, during overview of resident files, all files were found to be missing forms, including the Consent To Treat form (LIC627C), Appraisal Needs and Services form, and the Personal Rights form (LIC613) At 11:15AM, during overview of staff files, all were found to be missing multiple forms. This includes the Personnel Record (LIC501) and the Health Screening Report (LIC503). This also includes none of the staff having updated CPR/First Aid training. 11:50AM, administrator revealed that their certificate has not been renewed. At 12:00PM, it was discovered that emergency drills were not being conducted quarterly. 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. Administrator expressed interest in the Technical Support Program (TSP). LPA will create referral. Exit interview conducted, and a copy of this form, along with a copy of appeal rights, was provided to the administrator.