Routine inspection·August 27, 2025

On 08/27/2025 at 9:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Ma Mercedes Morales, Administrator, and explained the purpose of the visit. Facility has census of 4. The facility’s fire clearance was approved for one (1) ambulatory and four (4) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms one (1) occupied by staff and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 135.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-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 serviced on 08/20/2025. Emergency Disaster Plan was last posted on 09/02/2024. First aid kit was observed to be complete. Fire drill was last conducted on 08/02/2025. Continued LIC809C. Continued from LIC809. Four (4) staff records were reviewed; they were current and complete. LPA reviewed all four (4) resident records, four (4) out four (4) were missing appraisal needs and service plans. LPA also reviewed P&I and Medications during visit. LPA requested updated copies of the following documents to be submitted to CCLD by 09/03/2025. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Surety Bond Current Administrator’s Certificate Updated facility sketch Continue on LIC809C... Continued from LIC809C The following deficiencies were cited during visit: At 10:27AM, LPA observed hot water in residents shared restroom was 135.2 Degrees Fahrenheit At 10:43AM, LPA observed R2 has a bed with a full bed rail At 11:37AM, LPA observed R2 does not have physician order for full bed rail in R2's file. At 12:02PM, LPA observed during file review four (4) out of four (4) residents did not have appraisal needs and service plans Deficiencies 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. Appeal rights and a copy of this report provided to Ma Mercedes Morales.