Routine inspection·September 20, 2025

On 9/20/25 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Care Giver, Alexandria Zacarias, explained reason for visit and was permitted entry into the facility. Licensee, Josiane Jones and Care Giver, Elaine Salcedo arrived some time later. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 3 resident was present during visit. Currently no residents are on hospice, receiving home health services or on oxygen. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Last fire drill on conducted on 6/29/25. 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: Emergency and disaster plan incomplete. Let us know posting incorrect size. 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 09/26/2025: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview was conducted with Licensee. A plan of correction was developed by Licensee and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided. TSP was offered and accepted. LPA will make referral to TSP.