Routine inspection·October 21, 2025

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA met with the Administrator Carrie Acosta and informed them of the visit. The Administrator arrived shortly thereafter. The LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is inaccessible. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The LPA observed the fire extinguisher to be fully charged and last serviced on 10. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Medications are located in a locked filing cabinet near the kitchen area. First aid kits are located inside a kitchen drawer. Cleaning solutions items were inaccessible and locked away inside a kitchen cabinet. Continues on LIC809C... BEDROOMS: The facility is a single-story residential home with four (4) bedrooms, three (3) for resident's use and one (1) for staff. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.The staff’s bedroom is located next to the living room. Inside temperature was maintained at a comfortable level. RESTROOMS: The facility has two (2) bathrooms, one (1) for resident use and one (1) for staff use. Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. The sinks had sufficient liquid soap. OUTDOOR SPACE : The back patio has a covered outdoor area for residents’ use. There is a gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. There is one (1) locked shed in the back patio that is used for storage. Laundry units are located inside the garage. The garage is attached to the house but remains inaccessible to residents. The kitchen sliding door needs the screen door to be replaced, the glass door needs to be fixed to make it easier to slide open, as right now the door is difficult to open. The sliding back door also requires a ramp for easy access to the back yard. The Administrator will have the corrections done by 11/07/2025. RECORDS: Records review began at 11:00 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 1:30 p.m.; medications are centrally stored and locked in a cabinet in the kitchen area next to the refrigerator; medications are labeled and checked for expiration dates. The medications are documented properly on the centrally stored medications and destruction record. No errors observed during the medication review. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability - Emergency Drills No citations were issued. Exit interview conducted. A copy of the report was issued.