Routine inspection·October 1, 2025

At 2:00pm, Licensing Program Analysts (LPAs) Angela Panushkina and Perchui Milena Khurshudyan arrived at the facility to conduct an annual inspection. LPAs met with the House Manager and explained the reason for the visit. A tour of the physical plant was initiated at 2:05pm and the following was observed: The facility is cleared for six (6) Non-Ambulatory of which one (1) may be bedridden in room 3 only. Facility also has a approved hospice waiver for six (6) residents. Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. LPA observed there to be sufficient stock of perishable and non-perishable foods. Food storage and preparation areas are clean and inaccessible to pests. All knives were observed to be locked in the kitchen cabinet. The fire extinguisher was purchased on 11/15/2024. Medications: Medications and resident/staff files are kept in locked closet, located in a hallway. There is a complete first-aid kit it with all required supplies and with the first aid manual. LPAs also observed (insulin, and narcotic) medications stored in a small fridge Bedrooms: The facility has a total of ten (10) bedrooms of which six (6) are designated for residents use. Four (4) bedrooms are for live-in staff. The bedrooms are appropriately furnished with sufficient closet space and have sufficient lighting. All exit doors will have an auditory alarm. LPAs also observed that three (3) out of five (5) residents have 1/2 bed rail, however, upon review of files, no doctors order was available/observed. Continue on LIC809-C Bathrooms: Facility has three (3) bathrooms. All bathrooms were observed to have nonskid mats. Bathrooms have soap, paper towels and all trash cans have a lid. Extra towels and linens were readily available. The hot water temperature measured at 155.1°F. Common Areas: The facility maintains a comfortable temperature of 74°F. LPAs observed all common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. There is a functioning telephone on the premises. Smoke detectors carbon monoxide is located throughout the facility and at 2:30pm they were tested and observed to be operational. Laundry Room: The laundry is located by the staff room. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Outside Areas: The back of the facility has sufficient yard space. At 2:40pm, LPAs observed appropriate outdoor furniture, with a covered shaded area for the residents. The outdoor area is free of visible immediate hazards. LPAs discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Between 2:45pm to 3:50pm, LPAs reviewed records of five (5) residents and three (3) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentation. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809-D. Exit interview conducted. Appeal rights explained and copy of this report signed and delivered.