Routine inspection·March 18, 2026

On 03/18/2025 at 11:30AM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Administrator, Sakaraia Kata, and explained the purpose of the visit. LPA toured the facility with caregiver Sakaraia Kata. The administrator currently holds a certificate (#6077910740) that expires on 08/6/2027. The facility’s fire clearance was approved for twelve (12) Non ambulatory and six (6) Bedridden residents. Hospice waiver for twelve (12). LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of eleven (11) bedrooms, three (3) full bathrooms, and seven (7) half baths in bedrooms. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 74 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 136.2 degrees Fahrenheit. Night lights are maintained in hallways and passages to non private bathrooms. LPA observed residents’ bathrooms are equipped with grab bars no non slip mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 12/5/2025. First aid kit was observed to be complete. Fire drill was last conducted on 01/28/2026. Continue on LIC809C. Continued from LIC809 LPA reviewed six (6) resident and five (5) staff records, all were current and complete. LPA also reviewed a sample of residents' medication. LPA request the following documents to be submitted to CCLD by 3/25/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (all 9 pages) Liability Insurance A copy of Administrator License LPA observed the following deficiencies: At 1:10pm, LPA observed there was not any hot water in the shared bathroom near bedroom #1. There was not any hot water in bedroom #9 and #2. The hot water in the shared bathroom near bedroom #6 was 136.2 degrees F. At 1:15pm, LPA observed medication cabinet unlocked. At 1:25pm, LPA observed six (6) residents did not have a doctor's order for half bedrail. At 1:37pm, LPA observed facility having 4 bottles of shampoo and is requiring residents to purchase own hygiene products. 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. A copy of the appeal rights and this report provided.