Routine inspection·August 22, 2025

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff 1(S1) and explained the reason for the visit. Administrator Anna Fabergas was contacted and arrived shortly after. At approximately 09:40 am, with the assistance of S1, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detectors were tested and appeared to function properly. The fire extinguisher is located in the kitchen. The charge date is April 23, 2025. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the dining cabinets. Bedrooms: There were five (5) bedrooms designated for residents' use. Currently, Room 3 and Room 4 are vacant. All five bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There were three (3) bathrooms in the facility. Two (2) bathrooms in hallways, which are the main bathrooms, and one (1) bathroom in a private bedroom. All bathrooms were clean, properly supplied, and had functional fixtures. Water temperatures were: 106.2 and 108.5 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living rooms and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. The dining room table is large enough to seat the capacity of the facility. Seating, such as couches, where in good repair and seats the capacity of the facility. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The gate at the side of the home was checked to ensure no locks were installed, and that the exit and passageway were clear for emergency evacuation. (Continue on 809C) Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. Medications: Medications and Medication Records were reviewed for proper documentation. Temperature: The Facility maintains a comfortable temperature of 74 degrees Fahrenheit Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.