Routine inspection·August 18, 2025

On 08/18/25, 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 Brenda Rodriguez. Staff contacted Administrator (AD) Diana Diaz and she arrived shortly after. LPA toured the facility with AD. The facility was observed to be at a temperature of 72 degrees F, clean, in good repair, and no passageway obstructions were observed. The living room has sufficient seating for residents. Living room 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 120.7 degrees F. All bedrooms were toured and observed to have the required furniture and adequate lighting. Bathrooms were observed operational, with non-skid strips and grabbed bars observed for the showers and toilets. The hallway restroom hot water measured at 123.4 degrees F and the hot water to the restroom connected to the room measured at 121.6 degrees F. Extra linens and towels observed stored in a hall closet. Chemicals were observed stored and locked in the garage. The facility has a dryer and washer in the garage. The facility has an additional garage and freezer in the garage with an additional food supply. Outside of the facility toured and observed to be free of debris with adequate seating available for residents. The carbon monoxide/smoke detector was observed operational during inspection. Medications observed kept locked in facility office. Medications were reviewed along with MARS and observed to be administered as prescribed. A first aid kit is also stored in the office. A sample of resident files and staff files were also reviewed and observed to have required documentation. Continued in LIC 809C. Continued from LIC 809. The facility installed a door in one of the bedrooms and did not notify or submit proof to Community Care Licensing (CCL). Facility is to provide documentation and proof to CCL. A deficiency is being cited on the attached LIC 809D in accordance to California Code of Regulations, Title 22,Division 6. An exit Interview was conducted. A copy of this report and appeal rights were provided to AD, whose signature on this form confirms receipt of this report. 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. In addition, please provide the following: letter of intent indicating alterations that were done to the facility, submit LIC 200, provide updated facility sketch to reflect the alterations, and submit LIC 9054 by POC due date of 08/25/25.