Routine inspection·August 7, 2025

On 08/07/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Administrator Antonia Dionisio. The facility is licensed for six residents and approved for two hospice residents. Bedroom #1 is approved for ambulatory only. Bedrooms 2, 3, and 4 are approved for non-ambulatory residents. Annual Fees are current. The facility is a single-story home located in a residential neighborhood. There are four (4) bedrooms, two (2) resident bathrooms, 1/2 bathroom, living room, dining room, kitchen, laundry area, and attached garage. The Administrator and House Manager accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Resident bedrooms had the required furniture, bed linens, and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Continue to LIC809-C. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and the shower was free of mold/mildew and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinets. The first aid kit was available. The administrator tested the carbon monoxide detector and smoke detectors in the house. Devices were functional. Four staff records were reviewed, 4 out of 4 staff records had the required criminal record clearances or criminal record exemptions. Four resident records and two residents’ medication were reviewed. Deficiencies are being cited in accordance with the California Code of Regulations, Title 22, see LIC809D. During the facility tour, LPA observed Resident #4 (R4) in bedroom #5. The fire department inspection does not reference a bedroom #5 and the facility sketch on file with Community Care Licensing Division does not reflect a bedroom #5. Civil penalties will be issued, see LIC421IM. During record review, LPA did not observe an annual assessment for Resident #1 (R1) and Resident #3 (R3). An exit interview was conducted, Plans of Corrections developed, and technical assistance provided. A copy of this report and appeals was discussed and left with Administrator Antonia Dionisio.