Routine inspection·September 16, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 11:25AM. LPA met with staff and Administrator Jennifer Fernandez who arrived at 11:40AM. Entrance interview conducted. Beginning at 11:28AM, the LPA, along with staff and Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: LPA inspected the kitchen at 11:28AM. Knives and sharps are stored in a locked drawer. The facility has a sufficient supply of perishable and non-perishable food. Food was stored at appropriate temperatures. BEDROOMS : The facility consists of seven (7) total bedrooms; six (6) are designated for single-resident use and one (1) is designated for staff use and is kept locked. Bedrooms #1, #3, #4, #5, and #6 have exits to the exterior. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, closet space, and sufficient lighting. BATHROOMS : There are three (3) full bathrooms; one (1) in the main hallway and two (2) Jack and Jill's (between room #4 and staff room, and room #5 and #6) designated for residents, staff, and guests. LPA observed bathrooms to be clean, sanitary, and in operating condition with grab bars and slip-resistant surfaces. Hot water temperatures were measured in bathrooms and were between 112.8-117.7 degrees F, which is within the required range. Report Continued on LIC 809-C. COMMON AREAS : This includes the living room, family room, and dining room. LPA observed common areas to be clean and properly furnished at the time of the visit. The hardwired smoke detectors and carbon monoxide detector were tested at 11:49AM; all were operable at the time of the visit. There is one (1) fire extinguisher by the kitchen which was fully charged and last purchased 09/11/2025. There is a functioning telephone on the premises. Emergency exiting plans/sketch, license, personal rights, and other required postings are posted on the entry way wall. LPA observed auditory exit alarms to be functional and operating. OUTDOOR SPACE: The backyard has a covered patio area with furniture including a table and chairs. There were no bodies of water on the premises. One (1) pathway is used as an emergency exit which was free of obstruction, however, gate did not self-latch. Administrator stated the latch will be repaired. GARAGE/LAUNDRY: At 11:47AM, LPA observed the locked garage. The garage can be accessed from the side of the property and from the dining area by the kitchen. The garage contains additional supplies, washer/dryer, detergents, additional refrigerator/freezer, and emergency food/water supply. MEDICATION REVIEW: Medications are centrally stored and locked in a cabinet in the dining room. LPA began medication review at 11:52AM and medications for two (2) residents were observed. All medications were labeled and maintained in compliance with label instructions, and state and federal law. RECORD REVIEW: LPA began record review at 12:05PM. LPA reviewed two (2) out of two (2) resident files and four (4) staff files for documents including, but not limited to: TB test, staff training, fingerprint clearance, physician's report, appraisal, and personal rights. All two (2) resident files were missing an updated reappraisal within the last 12 months. Staff files were complete and had no missing documents. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill conducted on 09/11/2025. During today's visit, LPA obtained a copy of the facility's liability insurance. Pursuant to Title 22, CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiency may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.