Routine inspection·September 24, 2025

On 09/24/25 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Direct Support Professional, Reyna Martinez explained reason for visit and was permitted entry into the facility. House Manager, Virginia Jimenez arrived a short time later. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 4 residents were present during todays visit. 4 residents with restricted health conditions. 1 resident on home health. No hospice services at this time. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Resident rooms observed to have the required furnishings and with adequate lighting. Sharps, chemicals and medications were located in locked cabinets/closets and cupboards. LPA observed sufficient seating under covered patio areas. The following issues were observed during today’s visit: 1 of 6 residents were observed to be bedridden without the proper fire clearance. 4 of 6 residents observed to be diabetic and staff assisting with glucose testing/medication. 3 of 3 resident records reviewed did not have the required documentation. Emergency and Disaster Plan was observed inaccurate/incomplete. No plans of care for allowable health conditions for residents requiring them. Driveway concrete was observed to be broken up and the back yard flooded due to a broken pipe. Dryer vent in need of cleaning. Back doors (2) in need of weather stripping. Bathroom shower observed dirty in need of cleaning. Bedroom #2 door plate damaged and in need of repair. Kitchen drawer and bedroom #3 dresser broken and in need of repair or replacement. Dining room blinds broken and in need of replacement. CONT... CONT... Deficiencies cited per California Code of Regulations, Title 22, on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care. LPA requested the following documents to be submitted to CCL by 10/10/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), a current copy of the surety bond and liability insurance in order to update the facility file. Exit interview was conducted with House Manager, Virginia. A plan of correction was developed by House Manager and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided to House Manager.