Routine inspection·January 30, 2026

Licensing Program Analysts (LPAs) Tao and Mallett conducted an unannounced annual visit at the facility using the CARE inspection tool. LPAs met with Staff#1 upon arrival and Administrator Jeffrey Yang join shortly after. LPAs explained the reason for the visit to Administrator. Facility annual fees are current. Liability insurance coverage is current which covers from 06/28/25 – 06/28/26. This facility is licensed to serve six (6) non-ambulatory residents, age 60 and above and have one (1) hospice waiver approved. Dementia waiver is in place. Today’s inspection consisted of applying CARE tool, conducting physical plant, reviewing staff/residents records, checking residents’ food supply/medication, and interviewing staff/residents. Infection Control: Facility maintains an infection control plan was on file. Staff were observed practicing safe hand washing. Hand sanitizing was observed throughout. Hygiene supply and sanitizing materials were observed in each bathroom and changing station. (-continued on LIC 809C-) Physical Plant & Environmental Safety: The facility consists of an administrator office room, kitchen, living room, family room, dining room, six (6) resident bedrooms, one (1) staff bedroom, three (3) resident bathrooms, one (1) staff bathroom, a detached garage, a front yard, and backyard. Physical plant was conducted and observed the facility is in good repair indoor and outdoor. Facility is operating within capacity. A swimming pool was observed in the backyard which is secured with a 5ft fence with a locked gate and not accessible to the residents. Cleaning supplies and sharp materials were observed locked and inaccessible to clients. Outdoor space is furnished, shaded, and accessible to residents. Passageways and exit areas were observed free of obstructions. Restrooms were observed clean. Water temperature was tested within 107 - 108.7 degrees F., which is within the required 105-120 degrees F per Title 22 requirement. Staff/ Residents Records review: Administrator certificate is current, and the expiration date is 12/01/27. Staff and residents’ records were reviewed but files were incomplete. See LIC 809 D for citation details. Food Service: The kitchen was clean. The required two (2) days of perishable and seven (7) days of nonperishable were observed and stored separately from toxic/cleaning supply. (-Continued on LIC 809C-) Health-Related Services: Medications were reviewed. Medications are centralized stored and inaccessible to the residents. First aid kit was reviewed. Incidental Medical Services: Facility does not currently serve any residents with restricted health conditions. Disaster Preparedness: Emergency Disaster Plan LIC610E was observed and last reviewed on 2/07/25. A contingency plan was observed. Last emergency drill was conducted on 01/30/26. Exit: Deficiencies were noted during this visit and cited per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Administrator Jeffrey and LIC 809s and appeal rights were provided.