Routine inspection·October 15, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit. The LPA arrived at 9:53AM and met with the Administrator Hilda Cervantes and explained the reason for the visit. Entrance interview conducted. Beginning at 10:02AM, the LPA and the Administrator toured the physical plant areas inside and outside to ensure there were 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. There was a fireplace in the living room, which was observed to be screened and inaccessible. The facility’s hallways had two (2) closets: one (1) closet stored extra linens and locked facility files, and one (1) closet was secured and led to the facility’s attic. The facility maintained a comfortable temperature throughout the visit. Required postings were observed on the entryway walls. KITCHEN: Knives, medications, and cleaning supplies were stored inaccessible. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food. Emergency food and water were sufficient and stored in the kitchen. Food in the refrigerator and freezer were observed to be properly stored with labels and dates in addition to an extra freezer. Laundry machines were observed attached to the kitchen area and were operational. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were two (2) total bedrooms, both private and had direct exits to the outside. Bedroom #1 was approved for one (1) bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The LPA observed cameras in the resident bedrooms that were installed by the Licensee. The Administrator stated they utilize the cameras to supervise the residents and do not have an audio component. The facility’s camera policy was disclosed in the admission agreement; however, use of cameras in private areas is a violation of residents’ personal rights. The Administrator contacted the Licensee who removed the cameras during the visit. The facility plans to submit an exception/waiver request to the Regional Office to re-install the cameras. There was one (1) total restroom in the facility which was shared. The restroom was clean and sanitary and in operating condition with grab bars and non-slip surfaces. The restroom was sufficiently stocked with soap and paper products. Hot water was tested and measured at 115.7 degrees F, which is within the required range. OUTDOOR AREA: The outdoor area consisted of one (1) shared courtyard with the subsequent facility operated by the Licensee. It was observed to have patio furniture in good condition with shade. There were two (2) side gates: one (1) contained facility storage and garbage bins, and one (1) side gate is used for emergencies and had a self-latching mechanism. No bodies of water noted, and exits were free of obstructions. RECORDS: Record review began at 10:20AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 07/13/2025. One (1) fire extinguisher was observed in the kitchen and was recently serviced on 09/11/2025. Smoke and carbon monoxide detectors were tested at 11:09AM and were operational at the time of the visit. MEDICATIONS: Medication review began at 11:15AM. 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. Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiency was cited (Refer to LIC 809-D). Exit interview conducted. A copy of today's report and Appeal Rights were reviewed and provided.