Routine inspection·August 18, 2025

On 08/18/25 at 10:00 a.m., Licensing Program Analyst (LPA) Evelin Rios conduct an unannounced annual inspection. LPA was greeted by administrator, Emma Apolinario. Upon entry LPA observed required postings along the walls leading to the kitchen and bedrooms. LPA explained the purpose of the visit. This is a Residential Care Facility for the Elderly (RCFE) with a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident for a total capacity of 6 residents. At approximately 10:12 a.m., LPA along with the licensee representative, Amante Apolinario conducted a physical plant tour inside and out and the following was observed: Kitchen: The kitchen was observed clean and clear of clutter, appliances and fixtures were functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility. Knives were stored in a locked drawer in the kitchen. Medication was observed stored in a locked kitchen cabinet. Two fully supplied first aid kits were observed by the kitchen. Bedrooms: There are five (5) bedrooms designated for residents' use. Bedroom #1 can be shared. Resident occupied bedrooms were adequately furnished, equipped with appropriate bedding and linens, and provided with sufficient lighting. LPA observed a linen closet stocked with additional linens. Bathrooms: There is one (1) bathroom designated for residents' use. The bathroom was adequately stocked with hand soap, toilet paper, and paper towels, and all fixtures were in proper working condition. Hot water temperature read 118 degrees Fahrenheit. (Continued to LIC809-C) Common Areas : These included the living area and dining area. The common areas were clean and appropriately furnished with seating in good repair, televisions, and board games stored in the TV console. The smoke alarms are interconnected. LPA observed a carbon monoxide detector in the hallway leading to the bedrooms. Carbon monoxide detector was functioning properly. Licensee tested smoke detectors at 11:07 a.m., and were observed to be functioning properly. There are two (2) fire extinguishers located by the kitchen and they were observed fully charged one had a purchased date of 11/04/2024. Surrounding Grounds : The outdoor area was free of hazards and has a gazebo with outdoor furniture. LPA observed four (4) sheds used for storage locked an inaccessible to residents in care.. Laundry/Garage: Detergents and cleaning products are kept in the locked laundry room inaccessible to residents. LPA observed a washer. Door leading to the garage was locked. Facility keeps dryer and other cleaning products in the garage. Resident and Staff Files : At 10:30 a.m., LPA conducted a file review of two (2) out of two (2) resident records and two (02) staff records to insure compliance of licensing forms. LPA and the licensee reviewed Centrally Stored Medication and Destruction Records for proper documentation. Facility also keeps Medication Administration Records (MARs). LPA reviewed facility's current liability insurance, infection control plan, emergency disaster plan and last disaster drill conducted on 07/02/25. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during todays visit. Exit Interview Conducted. A copy of this report provided.