Routine inspection·March 3, 2026

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Staff#1 upon arrival and Administrator Ewa Nyczak join shortly after. LPA explained the reason for the visit to Administrator. Facility annual fees are current. The facility is licensed to serve six (6) elderly clients ages 60 and above with a hospice waiver for three (3) residents. Dementia waiver is in place. Today’s inspection consisted of applying CARE tool, conducting physical plant, reviewing staff/residents records, checking residents’ food supply/medication, and interviewing staff/residents. Infection Control: Facility maintains an infection control plan was on file. Staff were observed practicing safe hand washing. Hand sanitizing was observed throughout. Hygiene supply and sanitizing materials were observed. (-continued on LIC 809C) Physical Plant & Environmental Safety: The facility is a single story home located in a residential neighborhood and consists of four (4) resident bedrooms, two (2) bathrooms, a living room, a dining room, a kitchen, a laundry area, a sun room, a detached garage, front sitting area, and a back yard. Physical plant tour was conducted and observed the facility is in good repair in general. Facility is operating within capacity. Outdoor space is furnished, shaded, and accessible to residents. Passageways and exit areas were observed free of obstructions. Restrooms were observed clean. Water temperature was tested within 115 - 118.5 degrees F., which is within the required 105-120 degrees F per Title 22 requirement. Staff/ Residents Records review: Administrator certificate is current, and the expiration date is 9/22/26. Staff and residents’ records were available to review. Food Service: The kitchen was clean. The required two (2) days of perishable and seven (7) days of nonperishable were observed and stored separately from toxic/cleaning supply. Health-Related Services: Medications are centralized stored. Disaster Preparedness: Emergency Disaster Plan LIC610E was observed and last reviewed on 2/07/25. A contingency plan was observed. Last emergency drill was conducted on 12/24/26. (-continued on LIC 809C) Exit: Deficiencies were noted during this visit and cited per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Staff#1 and LIC 809s and appeal rights were provided.