Routine inspection·March 30, 2026

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Caregiver Yanina Cota. Administrator Hugh He arrived a short time later. And assisted with the visit. LPA observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance. The facility has an Infection Control Plan. 2. Operational Requirements: A current Plan of Operation was reviewed. The facility serves residents 60 years and older, has a Dementia Waiver in place, and a Hospice Waiver for one (1) resident is approved. A fire clearance for 5 non-ambulatory and (one) 1 bedridden resident is place. Liability Insurance in the amount of at least ($1,000,000) occurrence and ($3,000,000) in total annual aggregate is in place and expires 7/1/2026. 3. Physical Plant/Environment Safety: The facility is a single-story home located in a residential neighborhood consisting of 6 bedrooms; 5 bedrooms for residents (4 private & 1 shared) and 1 staff bedroom, 3 bathrooms, living room/ dining room, kitchen, outdoor covered patio area, laundry area is in the porch, and home has no garage. The facility has one (1) fully charged fire extinguisher that was inspected on 01/25/2025. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There is an empty water fountain located in the backyard. Kitchen drawers containing knives/sharp objects were inaccessible to residents. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Water temperature measured between 113.2 – 117.1 The shower sill in by the window needs to be cleaned. Refrigerator and freezer were unclean. 4.Staffing: A total of 3 caregiver staff provide care and supervision to the residents and are all over 18 years of age. (CONTINUED ON 809C) (continued from 809) 5. Personnel Records/Staff Training: Administrator certificates expire 8/06/2027. Personnel files/training were reviewed. Staff training, health clearance, criminal background clearance and 1st Aid/CPR training were checked. 6. Resident Records/Incident Reports: A total of four (4) resident files were reviewed. Files contained admission agreements that had monthly fee redacted. Physician's Reports for 2 residents needs to be updated., Appraisals, TB clearance, COVID-19 vaccine cards, Functional Capability Assessment, and emergency information. RCFE complaint poster and Personal rights were observed posted in the facility hallway. 7. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed daily. 8. Food Service: Sufficient food supply is stored in the kitchen and storage areas consisting of: 2-day perishables, 7-day non-perishables supplies are not sufficient. 9.Incident Medical and Dental: Four (4) centrally stored resident medications were reviewed. All four files reviewed had PRN without orders and labels. Medical and dental transportation is provided by family, transportation services, or staff. 10. Disaster Preparedness : Emergency and Disaster Plan LIC 610E is in place. The last emergency disaster drill was conducted on 02/09/2026. Need to update with second location away from facility. 11. Residents with Special Health Needs : One resident is receiving home health services. One resident is enrolled in hospice care. Individual Service Plans and Appraisals were observed in resident files. Deficiencies noted, technical violations issued Exit interview was conducted with Administrator Hugh He. A copy of the report was issued.