Routine inspection·April 9, 2026

On 04/09/2026 at 10:10AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a required 1- year inspection. LPA met with Caregiver, Augustine Bonete. Administrator, Joy Bisaha, arrived at 10:53AM, and LPA explained the purpose of the visit. The facility’s fire clearance was approved for four (4) ambulatory, three (3) non-ambulatory and three (3) bedridden residents LPA toured facility with Administrator, including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (6) total bedrooms, one (1) bedroom occupied by staff and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 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 109.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7-day supply of nonperishable and 2 days of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased on 05/13/2025. First aid kit was observed to be complete. Fire drill was last conducted on 01/30/2026. Continue on LIC809C…. Continued from LIC809 LPA reviewed four (4) resident records, LPA reviewed four (4) staff records all four (4) staff members were associated and have FirstAid/CPR. LPA observed the following deficiencies: At 10:46am LPA, was informed of Administrator not working at facility since February 16, 2026 At 11:07am, LPA observed hospital bed with rail in room#2, during file review LPA observed no physician orders for hospital bed with rails for R2. At 11:12am, LPA observed medication in a cup next to bed where R1 was laying in watching television. At 11:13am, LPA observed an unlocked kitchen drawer with sharps inside. At 1:45pm, LPA observed during file review and interviews, R1 was placed on hospice without physicians’ orders/knowledge. At 1:50pm, LPA observed during file review and interview, licensee did not notify CCL of R1 being placed on hospice within 5 days. At 2:11pm, LPA observed during file review, licensee did not update R1’s appraisal needs and service plan. At 2:35pm, LPA observed during file review, S3 and S4 do not have health screening and TB. At 2:37pm, LPA observed during file review, S2, S3 and S4 do not have training At 3:47pm during review of medication and Medication Administration Record (MAR), LPA observed facility was administering melatonin 10mg to R4 without physician orders . Continue on LIC9099C... Continued from LIC9099C..... LPA requested the following documents to be submitted to CCLD by 04/16/2026 . LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Updated Facility Sketch Administrator Certificate Deficiencies were cited from Title 22 California Code of Regulations (see LIC809D). Failure to submit proof of corrections by plan of correction due date, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided .