Routine inspection·August 20, 2025

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff designee, Anthony Espino and explained the reason for the visit. At 10:03 AM, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 10:29 AM smoke alarms were tested and are operational. There are carbon monoxide detectors that functions properly. The fire extinguisher is beside the kitchen and living room. During the visit the facility is at 80 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory; hospice waiver for one (1). Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in the dining area cabinets. Bedrooms: There were five (5) bedrooms designated for clients' and staff use. Four (4) of the that are in use by clients were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Room #1 and #3 are properly furnished and is for private used. Bedroom #2 and bedroom #4 are shared. There are one (1) staff bedroom in the facility and is located beside bedroom #4, staff bedrooms are locked with no medication in sight. Continue to LIC 809-C Bathrooms: There are three (3) bathrooms designated for residents' and staff use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 109.0 degrees Fahrenheit for bathroom #1 located in the hallway beside bedroom #2. Bathroom #2 measured 108.5 degrees Fahrenheit inside bedroom #4. Bathroom #3 is located inside staff bedroom. Cleaning supplies are being stored in a locked cabinet in the laundry room. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. Common Areas : These included the living room and dining area for residents. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Residents dining table fits enough for six (6). Office space is beside the living room. Fireplace is block-off, non-operational and inaccessible to residents. Surrounding Grounds : Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area and detergents are located by the laundry room by the kitchen that is kept secured. The facility does have a swimming pool or body of water. The garage is detached and is used for storage. Resident Files : LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files : LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Staff #4 (S4) was observed assisting R1 to go to a doctor appointment today and is observed to not be finger print cleared, civil penalty will be issued at LIC 421BG. Medications : Medication and Medication Records (MMR) were review for proper documentation. LPA observe R1 Epi pen and PRN Pepto Bismol was kept unlocked and accessible in the refrigerator. Deficiency will be issued in LIC 809-D. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies and civil penalty observed during the visit. Exit interview conducted and a copy of the report issued.