Routine inspection (multi-day)·August 21, 2025

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 Ivonne Lopez, caregiver for the facility, and explained the purpose of the visit. Administrator Tiffany Sasada was notified of the visit by phone call. There are five (5) residents residing within the home. 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: · Three (3) staff did not have their medical assessment with TB clearance available for review during the annual inspection. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, all six (6) of whom may be non-ambulatory, and a hospice waiver approved for one (1) resident. The facility consists of a kitchen, a dining room, a living room, three (3) resident bedrooms, two bathrooms of which Restroom #1 had a hot water temperature reading of 122.y Degrees Fahrenheit, and Restroom #2 which had a hot water temperature reading of 123.4 Degrees Fahrenheit, which were both over the required range of 105 – 120 Degrees Fahrenheit. LPA requested to tour bedroom #1 identified on the facility sketch that Community Care Licensing Division (CCLD) has on file dated 11/2/2015, however LPA was not allowed to tour the room. One of the non-ambulatory residents of the facility is currently residing in the “multipurpose room” of the facility, rather than one of the identified resident bedrooms based on the current facility sketch on file dated 11/2/2015. CCLD will be following up with the fire department in regard to the facility’s use of the multipurpose room. 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) residents, all of whom may be non-ambulatory, and a hospice waiver approved for one (1) resident. · Care and supervision to meet the clients’ needs was observed. Staffing: · Four (4) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Four (4) staff files were reviewed for criminal background clearance and training. · One (1) of the staff was not associated to the facility. · All four (4) staff members did not have current/valid CPR certificates available to review. Resident Rights/Information: · Physician orders were reviewed for five (5) resident files. · Medications were also reviewed for five (5) residents. · The Medication Administration Records (MARs) were not initialed by staff on 8/13/2025 and 8/14/2025 during the initial visit conducted on 8/14/2025. 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. · One (1) resident does not have their physician’s report on file. · Two (2) residents did not have a completed Pre-placement appraisal on file. 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: · Annual staff retraining on topics related to dementia care, hospice care, postural supports, and restricted health conditions were not available to be reviewed. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility. 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, and civil penalties are documented on the LIC421IM and LIC421BG pages. Exit interview held and a copy of the report along with appeal rights were provided.