Routine inspection·August 19, 2025

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jessica Lopez caregiver and explained the reason for the visit. The facility is licensed to serve (6) bedridden residents ages 60 and over. The facility is located in a residential area behind another home, and consist of a dining room, living room, kitchen, (3) resident bedrooms, (2) resident bathrooms, a back yard, a garage, and a shared front yard and laundry area. The following domains were reviewed during this visit: Infection Control : Facility does not have a copy of infection control. All staff have a TB clearance. Operational Requirements: Facility maintains a plan of operation, fire clearance. Facility is operating within the limitations of their license. They currently don't one resident under hospice care. A current liability insurance was observed and a copy was obtained. Physical Plant/Environmental Safety: LPA toured the facility with Jessica Lopez caregiver and observed the following. Facility was observed in good repair. Living room and dining room were observed with furniture and in good repair. Kitchen was observed clean. Cleaning supplies and sharps are maintained in a locked cabinet. Refrigerator/freezer and pantry were observed. Medication cabinet is located in hallway. Three (3) resident rooms were observed with sufficient lighting, required furniture and bedding supplies. Exit doors in each bedroom exiting the facility have a sound device that were observed not working at the time of the visit. Bed rails were observed in each residents' bed. Resident #1 and #3 have 3/4 bed rails and there is no physician's request on file. Two (2) bathrooms were observed in good repair and clean. Water temperature was tested in each bathroom sink and tested between 66.7 - 103.4 degrees F., which is not within the required 105-120 degrees F. (CONTINUED ON LIC809C) There are no large bodies of water at the facility. Carbon Monoxide/Smoke detectors were tested and are in working condition. Passage ways were observed clear of obstructions. Backyard and front yard were observed with shaded seating area. Staffing: Administrator certificate was reviewed for Chris Gutierrez was not available. LPA checked on the department's website and did not find a request for renewal. Linda Morales has an administrator certificate which is pending for renewal and is the responsible person. CPR/First aid training was observed for staff. Staff is on duty during the night shift. Personnel Records/Staff Training: LPA reviewed 5 staff files. Files were available for review. Files include; TB clearance, health screening, background clearance, personnel record, and training for each staff. Staff #4 does not have a health screening on file. Staff #5 is not associated to the facility and has been working since 10/20/25. Three staff were interviewed. Resident Rights/Information: License, Let us Know (PUB 475), Ombudsman, personal rights posters were posted throughout the home. Planned Activities: Facility provides activities such as puzzles, books and interactive dolls. Food Services: LPA observed at least 2 days of perishables and 7 days of non- perishable food supplies. An additional refrigerator was observed in the laundry area. Kitchen was observed clean and free of pest. Staff were observed practicing hygiene and infection prevention. Two out of three residents have a modified diet per medical assessments. Incidental Medical and Dental: Facility provides assistance with medical/dental arrangements and with medication assistance. Medications were observed stored in locked medication cabinet. LPA reviewed medication for 3 residents. Resident Records/Incident Reports: LPA reviewed 3 residents files, each contained admission agreement, medical assessment, TB clearance, pre-appraisal, and appraisal. One resident was interviewed. Disaster Preparedness: LPA reviewed emergency disaster plan LIC 610E(3/19) last reviewed on 5/25/24. Emergency drills are conducted monthly, last emergency drill was conducted on 7/14/25. Residents with Special Health Needs: Facility is serving 1 resident on hospice, resident #1. No bedridden. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Stacy Lopez Manager and a copy of this report, LIC 809D, and appeal rights were provided.