Routine inspection·May 22, 2025

On 05/22/2025 at 9:45AM, Licensing Program Analysts (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Marvic Datuin, Administrator and explained the purpose of the visit. The Administrator currently holds a certificate (#702258740) that expires on 06/14/2026. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms and four (4) bathrooms two (1) bedroom occupied by staff. LPA did not observe any bodies of water. A comfortable temperature is maintained at 81 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 122.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and no skid mats. 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 purchased on 03/01/2025. Emergency Disaster Plan was last posted on 12/01/2024. First aid kit was observed to be complete. Fire drill was last conducted on 04/02/2025. Continued on LIC809C. Continued from LIC809. LPA reviewed five (5) resident records and four (4) staff records; and they were all complete. LPA reviewed a sample of medication during visit. LPA requested the following documents to be submitted to CCLD by 05/29/2024 : LIC 200 and Updated Facility Sketch LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Continue on LIC809C Continued from LIC809C LPA observed the following deficiencies: At 10:05 AM LPA observed medication in a clear box and nasal spray on table next to a resident who was eating breakfast At 10:13 AM LPA observed unlocked medication cabinet At 10:18 AM LPA observed an add on bedroom located in the garage. 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. Exit interview conducted. A copy of this report and appeal rights provided.