Routine inspection·October 7, 2025

Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with Administrator Vivian Sison and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. The physical plant was inspected along with medications, food supply, and residents and staff records. The facility is licensed to serve (12) Non-Ambulatory Residents, with a Hospice Waiver approved for (3) Residents. The facility currently has 11 residents all of which are serviced by the San Gabriel/Pomona Regional Center. The facility is in a residential area. LPA toured the home and inspected 12 resident bedrooms, 6 Jack and Jill restrooms, 2 walk-in showers, 1 live in staff bedroom, one staff room, 1 staff bathroom, kitchen, 2 laundry rooms, dining room, living room, activity room / sunny room and outside activity area located in the backyard / courtyard. The back yard / courtyard is well maintained and there are no pools or large bodies of water. There is a shaded seating / patio area for the residents located in the backyard with proper furnishing. Passageways and exits are free of obstruction. LPA observed storage room door in the back of the facility was open during visit. Cleaning supplies and sprays were observed unlocked and accessible to residents. Resident bedrooms were checked. Each bedroom is equipped with the proper furnishings. Bedrooms also have sufficient closet space. The bathrooms and showers were toured. The hot water temperature was tested and measured within Title 22 Regulation guidelines. Laundry rooms were inspected. LPA observed laundry detergent are locked and inaccessible to clients. Clean towels and extra linen were observed in a hallway closet. Continue 809C The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and working properly. Sharps are locked and are inaccessible to clients. Smoke detectors and carbon monoxide detectors are operable and in compliance. Several fire extinguishers were observed and are fully charged. Last fire/disaster/earthquake drill was conducted on 09/29/25. LPA observed the centrally stored medications to be locked in the cabinet located in the kitchen and inaccessible to residents. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. LPA reviewed 5 resident’s files and observed that all files are updated. 4 staff records were reviewed to confirm health screenings, training, and fingerprint clearances. LPA reviewed residents medications. Medications are documented properly and given as prescribed. Deficiency was noted on LIC 809D. Exit interview was conducted. Copy of this report and appeal rights were provided to Vivian Sision.