Routine inspection·September 22, 2025

On 09/22/2025 at 8:23am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today's visit was to conduct the one-year inspection. LPA met with Edilberto Bernardino, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 residents from the age range of 60 and over ambulatory, of which 6 may be bedridden with a hospice waiver for 6. (4) of the residents are diagnosed with dementia, (2) residents receive home health, and (2) of the residents are receiving hospice care services. The facility does not handle any of the residents’ money. The facility has a current administrator certificate for Edilberto Bernardino (#708539740) valid from 09/17/2025 - 09/16/2027. The facility fees are current. The facility has liability insurance Kinsale Insurance #0100310726-2 with each occurrence of $1,000,000 and general aggregate of $3,000,000, effective from 07/01/2025 -07/01/2026 The home is a single home consisting of: (6) residents' rooms, (4) bathrooms of one of the bathroom are for visitors, (1) staff room, a living area, a dining area, a kitchen, an outside seating area, a backyard with a garden and an attached garage. Between the hours 12:25pm-12:45pm, LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. The water temperature measured at 117.1°F (in the bathroom #1), 119.8°F (in bathroom #2) and 119.1 °F (bathroom #3). Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards doorways were free of obstructions. Report continues on LIC 809-C Between the hours of 8:45 am - 2:15 pm, LPA conducted a records review of (6) residents records, (5) staff records and (5) Resident Medication Administration Records and the facility disaster plan. The facility disaster plan was current (last conducted on August 2025 at 1:26pm) and in compliance with Title 22 at the time of visit. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did observe deficiencies, and citations were issued at this time. LPA observed the following to be out of compliance with Title 22 regulations: 2 out of 6 resident did not have the LIC 625: Need and Appraisal Plan on file. 2 out 2 residents did not have a Home Health Care of Plan on file 1 out 2 resident did not have a Hospice CARE Plan on file 1 out of 6 staff did not have a LIC 503 Health Screening on file An exit interview was conducted Edilberto Bernardino, Administrator, and a copy of Report and Appeal Rights provided.