Routine inspection·September 2, 2025

On 09/02/2025 at 10:15AM, Licensing Program Analysts (LPAs) Carol Fowler and Andrew Christy conducted an unannounced 1-Year Required inspection. LPA met with caregiver Agnus Smith and explained the purpose of the visit. Administrator Elaine Johnson arrived at 11:00AM, the Administrator currently holds a certificate (#7003239740) that expired on 01/17/2026. The facility currently houses 4 residents out of the licensed capacity of 6. LPAs toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of 3 bedrooms. No bodies of water observed. A comfortable temperature is maintained in the home at 72 degrees Fahrenheit. LPAs 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 108.2 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 11/7/2024. First aid kit was observed to be complete. Continued on LIC809C... Continued from LIC809 LPAs reviewed four (4) resident files and four (4) staff files, all found to be complete. Facility has an emergency disaster plan last updated 05/13/2025. The facility last conducted emergency drills 5/18/2025. LPA observed the following deficiencies: At 10:55AM, LPAs observed cleaning solutions Windex, Ajax, Cascade, and Ajax in the outside storage unlocked. At 11:15AM, LPAs observed several expired cans of food in the garage. As well, laundry detergent was observed to be out in the open. Child locks were used to lock a cabinet containing cleaning chemicals like Comet, Lysol, and carpet cleaner At 11:30AM, an unlocked drawer in the kitchen was found to contain one pair of scissors and two lighters. LPAs asked for updated copies of the following forms: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance 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 of appeal rights and this report provided .