Routine inspection·October 23, 2025

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an Annual Required visit and inspection of the facility. LPA met Vicente Robles - Administrator and explained the reason for the visit. At 11:15am, with the assistance of Administrator, LPA took a tour of the physical plant. Required postings were observed in the dining area. The smoke/carbon monoxide detectors are hardwired and interconnected. At 11:40am, smoke and carbon monoxide detectors were tested and observed to function properly. The chime doors on each exit door, were observe to function properly as well. The fire extinguisher is located in the kitchen with charge date of 04/02/2025. Facility conducts quarterly fire drills; the last fire drill was conducted on 10/15/2025. Common Areas : These included the living room and dining room across from the kitchen and a sitting area at the front entry. The common areas were properly furnished with sofas, tables and chairs, appropriate for the number of residents. LPA observed several supply cabinets in the hallway. Laundry machine is located in the hallway and the laundry detergents were kept in locked cabinets atop the machines. LPA observed a bolted sliding door in the hallway; the door is completely shut and is inoperable. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. All food supplies in containers were marked with purchase dates, to ensure food and safety regulations. Knives were stored in a locked drawer in the kitchen. All kitchen surfaces and appliances were clean and sanitary. Continued on 809-C Bedrooms: There were six (6) bedrooms designated for residents' use. All the bedrooms were properly furnished with appropriate furniture, beddings and linens with sufficient lighting. Three (3) of the bedrooms have exit doors. LPA observed the exit door in bedroom #1 to be obstructed by a cabinet; citation will be provided. Currently bedroom # 6 is vacant. Bathrooms: There are three (3) bathrooms, one (1) for staff use and two (2) designated for residents' use; bedroom #5 has it's own bathroom. Both resident bathrooms had required grab bars and non-skid mats. Hot water temperature was measured at 110.5 and 111.7 degrees Fahrenheit. Surrounding Grounds : There are two exits, one in the living room and one in the hallway, which are used as emergency exits, leading to the backyard. There was furniture appropriate for outdoor use, underneath a covered patio. The outdoor area was free of hazards and landscaping is maintained beautifully. There is no body of water in the premises. There is a detached garage, where additional emergency food, water and supplies are kept. Facility has an electrical generator, cable and internet access. Resident Files : LPA conducted a file review of all resident records to insure compliance of licensing forms. Staff Files : LPA also conducted a file review of staff records to insure forms and training are up to date and in compliance with licensing forms. Medications : A locked cabinet near the kitchen is used to store medications. Medications for three out of five residents were counted and Medication Records were reviewed for proper documentation and administration. Facility has two complete first aid kits and a first aid manual. Required Documents : Administrator license expiration date is 12/21/2025. Liability insurance for the facility has an expiration date of 07/02/2026. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were cited (refer to LIC 809-D) during today's visit. Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.