Routine inspection·December 3, 2025

At approximately 11:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Cheryl Gambonini, Licensee. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care, all of whom were present during today's inspection. Facility is approved for six (6) residents, has a Dementia Care Plan, a Hospice waiver for three (3), and is approved for all non-ambulatory residents,. At approximately 11:30 AM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the front and backyards with outdoor space for activities. LPA observed another structure which was locked and is used as a bakery and the contents of which is mostly baking supplies and holiday decorations. Facility has an internet access device available for resident use. Facility has internet service available to residents in care and the telephone was tested an operational during inspection. Facility's 2 fire extinguishers were observed charged and were last serviced 12/2024. Licensee agrees to Continued on LIC809-C... Continued from LIC809C... have all facility fire extinguishers serviced immediately to remain in compliance with regulation. Smoke and Carbon Monoxide detectors were tested and 3 of 6 were non-operational during inspection. Licensee showed LPA new smoke detectors ready to be installed and called to schedule an electrician to relace them during today's inspection. Facility conducts bi-annual disaster drills, and the most recent drill was conducted 11/2025. LPA informed Licensee that drill shall be conducted on a quarterly basis moving forward, and Licensee agreed to bring the facility into compliance. LPA observed the facility's infection control plan, first aid kit, PPE, emergency supplies, and facility has a generator for emergency preparedness. LPA reviewed facility's emergency disaster plan last updated 11/2025. At approximately 1:30 PM, LPA conducted file review. Three (3) staff files and four (4) resident files were reviewed. All staff files reviewed were missing proof of all 20 hour of the required annual training and 2 of 3 were missing proof of all of the required initial 40 hours of training per regulation, (see LIC809D). Staff files reviewed have proof of current First Aid and CPR certification. Four (4) of four (4) resident files reviewed contained the required documentation. Licensee states that most of the residents' family members coordinate residents' medical and dental appointments and transportation to and from visits. However, Licensee is available to assist with this as needed. Medications and medication records were inspected and the logs were observed maintained in compliance with regulation. Facility does not handle P&I. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC500 - Personnel Report (updated) Proof of Liability Insurance (Updated) LIC610E - Emergency Disaster Plan (Updated) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted with Licensee whose signature on form confirms receipt of documents. Appeal rights provided.