Routine inspection·December 7, 2025

Licensing Program Analyst (LPA) Gary Tan, met with staff Teresa Giron for a One (1) Year Required visit for this facility. Ms. Giron called the Administrator Claudia Gutierrez and explained the reason for the visit. Administrator designated Ms. Giron to sign the report. A tour of the physical plant was conducted with the administrator at 12:19 PM. The facility is a single storey house with a total of three (3) bedrooms and three (3) bathrooms currently occupying four (4) residents. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden in Room #1. Hospice waiver for six (6) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of emergency food. Knives were kept locked in a kitchen drawer. Cleaning supplies and other toxins are stored in the garage which was locked during visit. BEDROOMS are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. BATHROOMS were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 110.1°F to 117.2°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. (continued on LIC 809-C) (continued from LIC 809) LAUNDRY ROOM: The laundry room is located in the garage. Laundry detergents and other cleaning agents were locked in a cabinet in the garage. The cleaning supply cabinet was observed to be locked during visit. COMMON AREAS: Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 74°F. Dual smoke/carbon monoxide detectors are hardwired and inter connected and observed to be operational. The fire extinguisher is located in the kitchen was observed filled and last bought on 12/07/25. MEDICATIONS: The medication cabinet is located in the bedroom hallway and was observed to locked and inaccessible during visit. A complete first aid kit is located in the kitchen. Staff/Resident Records: Resident records were reviewed and observed to be complete and updated at this time. Staff records were also reviewed and observed to be complete and updated at this time. SURROUNDING GROUNDS: The backyard of the facility has a covered patio and backyard furniture to accommodate the residents. The Garage is converted into an office/staff break room/laundry area. There is a tool shed on the backyard separated by a 3' gate and inaccessible to residents. There is a drive way at the back of the facility which could park three (3) cars at a time. Disaster drill was last conducted on 10/28/25. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted. Copy of this report.