Routine inspection·October 31, 2025

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit on 10/31/2025 and was greeted by two caregivers. LPA stated the purpose of the visit was to conduct an annual inspection. The caregivers confirmed there are four residents. The facility is licensed for five (5) non-ambulatory residents and one bedridden resident. LPA reviewed the resident files at 9:15 am until 9:45 am. LPA observed three out of four residents' files were missing documentation. LPA Spaeth and the caregivers toured the facility at 10:00 am until 10:45 am Common Areas – The family room, dining room, and kitchen are combined. The family room was furnished with comfortable seating and a television. The dining room area contained a dining room table and chairs. Kitchen - LPA Spaeth observed a two-day supply of perishable food and a seven day supply of non-perishable food. The knives were locked. The cleaning solutions were locked underneath the kitchen sink. The fire extinguisher is located near the kitchen and is operable. Medications: LPA observed the resident medications, first aid kit, and PPE supplies were safely locked in a kitchen cabinet. Continued on 809-C Resident Rooms: The resident rooms were furnished with a bed, linens, night stand, lamp and chair. Bathrooms: The bathrooms contained hand soap, paper towels, grab bars, trash can, and slip resistant mats. Laundry Room & Staff Room: LPA observed the laundry room door was not locked and the laundry detergent, washer and dryer were in the room. Another door led to the garage and staff room and that door was not locked. LPA observed tools were laying on the garage floor and were not locked in a secure area. LPA reminded staff the door leading to the laundry room should be locked at all times. Water Temperature : The water temperature was tested at 10:20 am and was 112 Degrees F. Hallway Cabinet- LPA observed the clean linens were located in a cabinet. Surrounding Grounds : There were no visible hazards, and passageways were free from obstruction. The side gate of the house was closed and was not locked. Comfortable seating is also located in the backyard in a shaded area Smoke/Carbon Monoxide Detectors : The smoke and carbon monoxide detectors were tested 10:45 am and were operable. LPA Spaeth reviewed the staff files at 10:45 am until 11:15 am. LPA reviewed the medications at 11:15 am until 11:30 am. Based upon Title 22 Division 6 of the CA Code of Regulations, the following deficiencies are issued (See 809-D). Exit interview conducted, appeal rights were discussed, and a copy of the report was given.