Routine inspection (multi-day)·December 11, 2025

Licensing Program Analyst (LPA) Elena Mallett arrived at the facility to conduct an Annual Continuation Visit. The initial Annual visit was on 12/09/25. LPA Mallett met with Staff in Charge/ Caregiver Adrianne Gray. LPA Mallett arrived at the facility at 8 AM. The door bell was rung several times and the door knocked on and LPA Mallett verbally announced Licensing was at the door. Two phone numbers on LIS were called twice and messages left. At 8:40 AM LPA Mallett gained entry into the facility when residents were seen leaving the facility to board the Day Program Bus.Licensing Program Manager (LPM) Fernando Fierros joined the visit shortly after. LPA Mallett was informed by Staff in charge that Licensee Percy Olidan was not present at facility due to a personal matter. Staff in Charge was not able to make contact with Licensee despite several attempts. As staff in charge, Adrianne Gray agreed to sign for the report and be present for the visit. The majority of CARE tool domains had been surveyed and documented in the Licensing Report for the initial Annual visit on 12/09/25. Deficiencies that were found then will be cited today. The facility was toured today, 12/11/25 and risks to health and safety of residents were assessed. There was sufficient staffing to meet the needs of resident in care but Staff in Charge did not have a current CPR in personnel file. Toward the end of the day Staff in Charge showed a current CPR training on phone. A print out will be added to file at later date. Smoke detectors throughout the facility ( in non-occupied resident room, living room, hallway,staff rooms) were observed to be missing or inoperable. See 809-D. On 12/09/25 visit the following was observed: Continued on 809-C Physical Plant & Environment Safety Continuation: On 12/09/25 LPA toured the facility and deficiencies observed are being issued today . Area along the side of the building was obstructed by patio furniture. Area in carport was obstructed by a desk and furniture. The curtain rod in the living room was not properly secured. Closet doors in both resident bedrooms were not functioning properly and needed repair. See 809-D LPA measured water temperature in resident bathroom to be 122.5 F. This is outside Title 22 regulations. See 809-D LPA observed the outdoor detached storage room was partially sectioned off to create an additional staff room. This was not on facility sketch. Another bathroom not on the facility sketch was observed by the breakfast nook.Licensee did not provide permits from the city for alterations. See 809-D Per interview with Licensee and Caregiver an unoccupied resident room on the facility sketch was being used intermittent ly by staff as a bedroom. See 809-D Carbon monoxide detector was inoperable and not permantely secured. See 809-D Staffing : There is staffing to cover all shifts. Resident Records-Incident Reports: LPA reviewed 4 resident files and medication logs. Resident 3 (R3)’s file did not contain a TB test. See 809-D Personnel Records-Training : 3 staff records were reviewed. All staff had criminal background clearances. Only one staff file contained current CPR training. No current First Aid training was observed in any of the staff records. See 809-D. Licensee was the Administrator but certificate was not renewed. See 809-D . Staff 3 ‘s file did not contain a TB test. See 809-D. Residents Rights-Information : Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Residents attend a Day program. Licensee advised to offer planned activities in the home in addition to this. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishable. See 809-C Incidental Medical & Dental: LPA observed the following during 12/09/25 visit: Medication is stored centrally in a locked staff room however, LPA observed several medications outside the medication room on a table near the glass cabinet near the living room that was accessible to residents. See 809-D. Medication is properly labeled and in their original containers . LPA observed and Licensee confirmed that two days of medications were prepared in advance and stored in pillboxes for dispensing. See 809-D During medication review LPA observed medication Melatonin for Resident #1 (R1) for which there was no current physician’s order. See 809-D Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: There are no bedridden or residents using hospice or home health services at this time. Residents Rights-Information : Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Liability Insurance in the requisite amounts of 1 million per and 3 million aggregate was not provided. See 809-D Continued on 809-C . LPA Mallett attempted to contact Licensee to verbally convey the content of this report but was only able to leave a voice message. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit. An exit interview was conducted with Staff in Charge and a copy of this licensing report along with appeal rights was provided.