Routine inspection·November 4, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:40AM. The LPA met with the Licensee Jefferson Reyes and explained the reason for the visit. Entrance interview conducted. Beginning at 10:44AM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. Nightlights were observed throughout the facility. The facility maintained a comfortable temperature throughout the visit. The LPA observed required postings along the entryway walls. KITCHEN: Knives were stored inaccessible in a drawer in addition to secured cleaning supplies under the kitchen sink. Kitchen appliances were in good and operable condition. The facility had a sufficient supply of perishable, non-perishable, and emergency food. Food in the refrigerator and freezer were of good quality. Resident files and medications were locked and inaccessible. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were six (6) total bedrooms: five (5) resident bedrooms and one (1) staff bedroom. Bedroom #4 had a direct exit to the outside and was approved for one (1) Bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were observed in the hallway. The LPA explained to the Licensee that the live-in staff room must remain locked and inaccessible to residents at all times. The Licensee understood and stated they will purchase a lock for the door. There were three (3) total restrooms: one (1) private resident restroom, one (1) shared resident restroom, and one (1) staff restroom. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper products. Hot water was tested and measured between 112.6 degrees F and 113 degrees F, which was in the required range. OUTDOOR AREA: The rear of the house had a laundry room with operational machines in good condition. Cabinets in the laundry room contained general storage, emergency water, and laundry detergent. The backyard had a covered patio area equipped with furniture for residents’ use. There was one (1) side gate for emergency exit use and was self-latching. All exits and passageways were free of obstruction. The rear yard also had a detached garage and a shed that contained general storage and was inaccessible to residents. Additionally, the garage had an attached driveway with a manual gate. RECORDS: Record review began at 11:09AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. The LPA observed four (4) out of four (4) resident Appraisals/Needs and Services Plans were not signed by the residents or their conservators. The Licensee stated they would flag the documents and obtain signatures. The LPA also explained the importance of updating resident Appraisals and Physician’s Reports annually per regulation. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The LPA reviewed training requirements with the Licensee as annual staff training did not include eight (8) hours of dementia training and eight (8) hours of medication training. Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, the LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 10/02/2025. Smoke and carbon monoxide detectors were tested at 12:06PM and were operational at the time of the visit. The facility’s magnetic fire door did not trigger and self-close during this time. The Licensee stated they will have the electrical wiring of the fire door checked. Fire extinguishers were fully charged and purchased on 9/26/2025. MEDICATIONS: Medication review began at 12:14PM. Medications were centrally stored and kept inaccessible. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. An immediate civil penalty of $500 for a violation of the facility’s fire clearance was issued (Refer to LIC 412M). The Licensee understands that continued violation of the facility’s fire clearance may result in additional civil penalties. Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D). Exit interview conducted. A copy of the appeal rights and today's report was reviewed and provided.