Routine inspection·February 25, 2026

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by Jessica Leano, Staff. Today's visit was conducted with Michael Custodio, Francis Martir, Administrator did not participate in today's visit due to a prior commitment. The reason for today's visit was provided. The facility is a single storey building consisting of a kitchen, dining room, living room, 9 bedrooms of which 3 bedrooms located in the front are used for live-in staff, an attached garage and detached back house was previously rented and is currently vacant. A copy of the building permit was requested for the back house. The facility is fire-cleared for 3 AMBULATORY in bedroom #3 and bedroom #4, 2 NON-AMBULATORY in bedroom #1 and bedroom #2 and 1 BEDRIDDEN resident in bedroom #5. The home has an approved hospice waiver for 6 residents. On today's visit the only domain reviewed on the CARE Inspection Tool was the Incidental Medical and Dental domain, 4 resident files and medications for Resident #2, Resident #3 and Resident #4 were reviewed. Resident #1's medication was not reviewed as the resident retains their own medications in their own room in a locked plastic box. The following was noted: Residents #1, #2 and #4 have not received an annual medical assessment Resident #3 does not have any evidence of a TB test Resident #3 and Resident #4 are prescribed PRN medications but there were no completed PRN continued on LIC809-C Page 2. Authorization Letters observed in their files Resident #1 does not have a current Appraisal/Needs and Services(ANS). The last assessment was done April 2024. per review of Resident #2, Resident #3 and Resident #4's medications, the medications in the bubble packs do not match the medications that were dispensed. Medications noted as being dispensed on the Medication Administration Record(MAR) were still observed in the bubble pack. Evening medications noted for the evening were dispensed in the morning. Medications from the bubble pack were missing from today(2/25/26 through 2/28/26 were missing. The MAR log for Resident #1, who is hospitalized from the evening of 2/24/26 and still in the hospital as of today's visit, indicate that their medications were dispensed. Medications are dispensed once a day when the label on the bubble pack indicates it is to be dispensed twice a day. The facility does not have copies of the physician's orders for the centrally stored medications. Due to the difficulty in obtaining facility files and the issues with the medications all the other domains of the CARE Inspection Tool could not be reviewed. A return visit is needed to complete the required annual inspections. Any citations not addressed on today's visit will be addressed on the return visit. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 18. Exit interview was conducted, APPEALS RIGHTS discussed and a copy was provided.