Routine inspection·June 17, 2025

Licensing Program Analysts (LPA), Mayra Cota, conducted an unannounced Required 1 year visit. LPA was granted entrance and met with Dolores Del Caremen Ortiz, Caregiver, and the purpose of the visit was explained. Stacy Santana Lopez, Manager, arrived shortly thereafter. There are four (4) residents currently living in the facility. The facility is licensed to serve (6) non-ambulatory residents ages (60) and above. Hospice waiver approved for (1) resident. The facility is operating within the scope of its licence. The facility is in a residential area of Pasadena and it consists of living room, dining room, kitchen, five resident bedrooms, (1) full and (1) half bathroom, laundry/supply room and front and back yard. During today's visit, the following was observed: Facility is clean and walkways, ramps and staircases are free of debris and obstructions. Furniture throughout the facility was observed in good repair. There is sufficient seating in the living and dining room for residents. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen. There is a closet in the hallway with extra clean linen and towels for residents. Kitchen appliances were clean and were operating at the time of visit. Sharps are locked in a kitchen cabinet and are inaccessible to residents. Cleaning supplies and toxins are locked in a cabinet under kitchen sink. Sufficient supply of 2 day perishable and 7 day non-perishable food was observed and an additional emergency food supply was observed in the Laundry. Food is labeled and kept within expiration limits. An over flow refrigerator is kept in the laundry room and was observed stocked with extra food. ***Continues on LIC 809- C Both bathrooms were inspected and were observed clean and sanitary. Shower in main bathroom has grab-bars and anti-slip mats. The water temperature was tested in both bathrooms and measured at 113.5 degrees F in bathroom 1- and 112.9 degrees F in bathroom 2, which is within the required 105 - 120 degrees F. Sufficient personal hygiene supplies for residents were observed in laundry room for residents in care. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area accessible to residents, located in the front and backyard. Patio furniture observed clean and in good repair. Gardens are maintained and passageways and exits are free of obstruction. Laundry room in the back of the house was observed free of clutter and washers and dryers were observed to be operable during visit. Basement entry way observed in the backyard was locked and inaccessible to residents. Smoke detectors were observed throughout the facility and were tested and observed to be working properly. Carbon monoxide detector located in the hallway was also tested and was also observed to be working properly. Two fire extinguisher, one located by the kitchen and one in the laundry room were observed to be charged and were last inspected on 5/31/25.. Last fire/safety drill was conducted on 6/2/25. Exit doors are equipped with door chimes and were tested and working properly. Fireplace in the living room is covered and is inaccessible to residents. Four resident and five staff files were reviewed and contained required documentation. Files were observed locked appropriately. Medication observed centrally stored, locked and inaccessible to residents. Medication review was also conducted and medication was observed to be administered and documented accordingly per physician's orders. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed and noted during today's visit. Exit interview held with Stacy Santana Lopez, Manager, and a copy of the report was provided.