Routine inspection·July 8, 2025

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Annual Required visit for this facility. LPA met with the administrator, Mark Belmonte and explained the reason for the visit. The facility is licensed for a total capacity of six (06) with fire clearance for five (05) non-ambulatory residents, and one (01) bedridden. At approximately 12:00 p.m., LPA and administrator toured the physical plant of the facility inside and out and the following was observed: At entry LPA observed a sign in log for visitors and a digital thermometer affixed to the wall. LPA observed appropriate postings. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of two day perishable and seven day non-perishable food at the facility, properly stored. Knives and sharps were stored in a locked kitchen drawer. LPA observed cleaning supplies locked under the kitchen sink cabinet. Centrally stored medication was observed locked in a kitchen cabinet. One (01) fire extinguisher in the kitchen was observed fully charged with service date 07/12/2024. Surrounding Grounds : Entry/exits were free of obstructions. The outdoor patio offers shade and there was furniture appropriate for outdoor use. The outdoor area was free of hazards and fenced in. No bodies of water observed. There are dual carbon monoxide and smoke detectors that are hard wired and interconnected though out the facility. Administrator tested detectors at 12:25 p.m., and LPA observed detectors functioning properly. Fire door closed when test was conducted. (Continue to LIC809) (Continued from LIC809) Bedrooms: Five (5) bedrooms are designated for resident use one (1) of which may be shared. Bedrooms were observed to be properly furnished with appropriate furniture, bedding and sufficient storage and lighting. One (1) hallway cabinet was observed to have first aid kit and first aid kit supplies. Another closet stored extra linens and towels. Bathrooms: There are three (3) bathrooms available for residents' use. Bathrooms were supplied with toilet paper, paper towels, hand soap, nonskid matts and grab bars. LPA observed night-lights in the hallway leading to the bathrooms. Hot water temperature was measured from two (02) bathrooms at 12:30 p.m., and read 111 degrees Fahrenheit, within regulation. Common Areas : These included the living rooms and dining area. The common areas were clean and clear of clutter, properly furnished. The dining room table is large enough to sit the capacity of the facility. Seating such as couches and arm chairs where in good repair and sit the capacity of the facility. A fireplace was observed off and secured with a screen. During visit LPA observed residents sitting in the living room with family visitors. LPA observed two (2) portable telephones accessible to residents. Laundry and Garage: The laundry room is located in the hallway by the residents' rooms and leads to the attached garage. Laundry room was observed locked. Detergents and cleaning supplies were observed locked in the laundry room. LPA observed a freezer and a refrigerator in the garage with extra food. Resident, Staff, and Facility Files : At 12:57 p.m., LPA conducted a file review of five (5) out of five (5) resident records to ensure compliance of licensing forms. LPA also conducted a file review of two (2) staff records to ensure forms and training are up to date and in compliance with licensing forms. LPA reviewed facility's liability insurance and emergency disaster plan (LIC610E.) Facility had not documented an emergency disaster drill for their last quarter. Medications : At 2:27 p.m., LPA reviewed Medication and Medication Records. Medications were reviewed for proper storage and documentation. Facility also maintains a Medication Administration Record (MAR). Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.