Routine inspection·April 30, 2025

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Gina Agustin and advised her of the purpose for the visit. At approximately 12:00pm, LPA took a tour of the physical plant. The facility is a one (1) story building. There is an exterior fence/gate in the front yard that is only locked from the outside. Gate/door is single action. It unlocks and opens from inside the compound when exiting. The smoke alarms and the carbon monoxide detectors are dual and interconnected. The fire extinguisher is located in the living room It was purchased on 05/01/24. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, sealed and properly stored. Knives were stored in a locked drawer. No cleaning supplies or cleaning agents observed out during the day's inspection. Bedrooms: There are four (4) bedrooms. Three (3) are designated for client use. Bedroom #1 is private. Bedrooms #2 and #3 are shared rooms. One bedridden resident can be placed in either bedroom #1 or #2 (per STD 850). Bedroom #4 is reserved for staff. Rooms designated for resident use were furnished with beds, night stand, chairs, dresser, bedding and linen. Resident bedrooms have sufficient lighting and closet space. Bathrooms: The facility has three (3) bathrooms. Bedroom #3 has it's own bathroom with shower. The other bathroom is located in the hallway, outside of bedroom #3. The third bathroom, is designated for staff. It is located by the kitchen. The bathrooms, designated for resident use were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 120 degrees. Common Areas : These included the living room and dining area. The living room has a couch, bookshelf, side and coffee table. The dining room table is large enough to seat six (6) residents. LPA observed furniture to be maintained and in good repair. The floors were mopped and clean. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds : Passageways and entrance were clear of obstruction. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space to hold activities. There is storage space in the back that is kept locked. There is no swimming pool or bodies of water. Laundry Area: The laundry area, where detergents and cleaning supplies are kept locked, is located by the kitchen. Garage: Facility has an enclosed garage attached to the home. It is used for storage. Work Station / Office: Staff office where medications, staff and resident records are maintained, is located by the living room. Resident Files : LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files : LPA also conducted a file review of staff records to insure training documents and licensing forms are in compliance. Medications : Medication cabinet is maintained in the staff office. Medication and Medication Records were reviewed for proper storage and documentation. 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.