Routine inspection·October 15, 2025

At 10:15 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by the Administrator, Flor Lobo. LPA explained the purpose of the visit. LPA observed required postings in the entry area and accessible hand sanitizer, gloves, and masks for visitors. LPA was asked to sign in the visitors log and take their temperature. This is a Residential Care Facility for the Elderly (RCFE) . A fire clearance was approved on 01/03/2025 for two (2) ambulatory and four (04) non ambulatory residents. At 10:20 a.m., LPA initiated a physical plant tour of the inside and outside of the facility. The following observations were made: At 10:22 a.m., LPA observed the administrator test the hard wired, interconnected, dual smoke and carbon monoxide detectors. Smoke and carbon monoxide detectors were observed to be functioning properly. Kitchen: The kitchen appliances and fixtures appeared functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility. LPA observed some repackaged food that was properly stored in clearly labeled, containers. LPA observed knives and sharps locked in a kitchen drawer inaccessible to residents. The fire extinguisher is located in the kitchen and was observed fully charged with service date 06/02/2025. Common Areas : These included the living area and dining area. The common areas were properly furnished. The couches and the dining table sits the capacity of the facility and were observed in good repair. A fireplace in the living area was properly screened. LPA observed a facility telephone accessible to residents. Overall the facility was clean and clear of clutter. (Continue on LIC809-C) (Continued form LIC809) Bedrooms: There are a total of five (5) resident bedrooms, one (1) of which is shared. Bedrooms were furnished with beds, night stands, chairs, appropriate bedding and linens, and sufficient lighting. Rooms with exit doors had auditory alarms that were observed on and functioning properly. LPA did not observe any tripping hazards. Bathrooms: There are three (3) bathrooms designated for resident use. One (1) is located in a shared bedroom. Bathrooms were properly supplied with hand soap, toilet paper and paper towels. LPA observed non skid matts or non skid shower floors and grab bars. Hot water temperature was taken from one (1) bathroom at 10:43 a.m. and read between 113.9 degrees Fahrenheit. LPA observed night lights in bathrooms, bedrooms and the hallways leading to the bathrooms. Surrounding Grounds : Entry/exits were free of obstruction. The outdoor area was free of hazards and has a covered patio with outdoor furniture. The laundry room leads to the attached garage and is kept locked and inaccessible to residents in care. Detergents and cleaning products are kept in the garage locked. In the garage LPA observe a deep freezer and emergency food and water. Facility / Staff / Resident Files : At approximately 10:56 a.m., LPA conducted a file review of four (4) staff records and three (03) out of three (03) resident records to insure compliance of licensing forms. LPA also reviewed the facility's active Certificate of Liability Insurance, Emergency Disaster Plan and Infection Control Plan reviewed by administrator on 10/01/2025. Facility had conducted a disaster drill with staff regarding power failure, fire and bomb threats on 08/10/2025 and have scheduled to participate for the national Shake Out drill on 11/01/2025 to complete their Q4 drill. LPA's review of LIC500 indicated their is coverage 24/7. LPA observed centrally stored medication, first aid kit and records are stored in a locked closet. At approximately 11:49 a.m., LPA reviewed Centrally Stored Medication Records for completeness. Facility also keeps a Medication Administration Records (MAR). Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit interview conducted. Copy of this report issued.