Routine inspection·August 27, 2025

On 08/27/25, Licensing Program Analyst (LPA) J. Duarte arrived unannounced to conduct the required Annual inspection. LPA introduced self, stated the purpose of the visit, and met with staff Margarita Pena and Marina Solorzano De La Cruz. Staff contacted (AD) Diana Diaz. LPA contacted AD Jason Johnson and advised the purpose of this visit. LPA asked Jason if he would be available and he stated that AD Diana will be reporting to the facility to assist with this inspection. AD Diana arrived shortly after and a tour was conducted. The facility was observed to be at a temperature of 74 degrees F, clean, in good repair, and no passageway obstructions were observed. The living room has adequate seating for residents and it has a fireplace with a cover. The kitchen was toured and LPA observed an adequate supply of perishable and non-perishable food. The facility stores kitchen knives in a locked hallway closet. A fire extinguisher was observed in the kitchen, with a service date of 05/23/25. The kitchen hot water measured at 113.5 degrees F. Both bedrooms were toured and observed to have beds, dressers, and adequate lighting. Bathrooms were observed operational, with non-skid strips and grabbed bars. The hallway restroom hot water measured at 106.4 degrees F and the hot water to the restroom connected to the room measured at 114.7 degrees F. The garage was toured and chemicals and and laundry detergent were stored in a locked cabinet. The facility has a dryer and washer in the garage, AD Diana stated that the facility does their own laundry. The facility has an emergency food supply in the garage, and the facility has an additional refrigerator in the garage with an additional supply of food. Outside of the facility toured and observed to be free of debris. The carbon monoxide/smoke detectors were observed operational during inspection. Medications observed kept locked in hallway closet. A first aid kit is also stored with the medication. All resident files and a sample of staff files were reviewed and observed to have required documentation. Continued in LIC 809C... Continued from LIC 809. LPA toured facility bedrooms and in Bedroom Number Three, LPA observed Resident One's (R1) bed obstructing the fire exit in bedroom number three. A deficiency is being cited on the attached LIC 809D in accordance to California Code of Regulations, Title 22,Division 6. *** A Civil Penalty is being assessed LIC421IM.*** AD Jason Johnson arrived after LPA toured facility and LPA discussed with him, LPA's observations. An exit Interview was conducted. A copy of this report and appeal rights were emailed to AD Diana. LPA requested the following updated forms be faxed to CCL Department: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage and Administrators certificates.