Routine inspection·May 20, 2025

On 05/20/2025 at 1:25 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Josephine Holgado, and explained the purpose of the visit. Administrator was unable to come and gave authorization on the phone for staff to sign the report. Administrator certificate is current. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which all bedrooms are occupied by residents and 1 bathroom. There are no bodies of water observed. A comfortable temperature is maintained at 72 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 109.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 05/09/2025. Emergency Disaster Plan was last posted on 05/20/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 04/26/2025. At 2:16 PM, LPA reviewed 6 residents records. At 2:52 PM, LPA reviewed 4 staff records and all are associated to the facility. At 4:30 PM, LPA reviewed two samples of resident’s medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/28/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Current Administrator’s Certificate THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 2:00 PM, LPA observed a knife and scissors unlocked in the kitchen near the sink. At 3:33 PM, LPA observed that staff did not have sufficient training hours. At 3:45 PM, LPA observed that S3 and S4 did not have a LIC503 and TB test on file. The Facility was 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 with Staff. Appeal Rights and a copy of this report provided.