Routine inspection·May 7, 2026

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Wilma Carstensen, administrator for the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. The facility consists of a kitchen that contains the facility washer and dryer, a dining room, two (2) staff rooms, a living room, four (4) resident bedrooms, an attached garage, two bathrooms of which Restroom #1 had a hot water temperature reading of 110.8 Degrees Fahrenheit, and Restroom #2 which had a hot water temperature reading of 125.7 Degrees Fahrenheit, which exceeds the required range of 105 – 120 degrees Fahrenheit. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has a fully charged fire extinguisher kept in the facility. Operational Requirements: · Fire clearance was approved by LA County Fire Department for a capacity of six (6) non-ambulatory residents, and a hospice waiver approved for four (4) residents. · Care and supervision to meet the clients’ needs was observed. Staffing: · Three (3) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Three (3) staff files were reviewed for criminal background clearance and training. · All Three (3) staff records reviewed have a health screening with a Tuberculosis clearance, and Three (3) staff have First Aid/CPR trainings that are active. · One (1) staff member Staff #1 still needs to have their annual retraining training on topics of dementia care documented per the administrator. · The administrator’s certificate is currently pending renewal based on the Administrator Certification Bureau website dated 5/1/2026. Administrator showed LPA required payment was made to approve certificate by 5/7/2026. Resident Rights/Information: · Physician orders were reviewed for five (5) resident files. · Medications were also reviewed for five (5) residents. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. · During interviews with staff it was revealed Resident #1 passed away on 4/27/2026, however a death report was not received by CCLD. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility and LPA obtained a copy. · The last emergency and disaster drill was conducted on 4/8/2026. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit is documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights were provided.