Routine inspection·December 1, 2025

On 12/01/2025 at 11:20am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Romina Ocampo (Direct Care Staff) and Rommel Dungca (Licensee)and explained the purpose of today’s visit. The facility is licensed to serve (18) elderly adults ages 60 and above, of which (18) can be non-ambulatory. The facility has an approved hospice waiver for (4). The facility has a current administrator certificate ( 7033913740 ) for Rommel Dungca valid 07/09/2025 - 07/08/2027. The facility fees balance is at $0. The liability insurance is current and is valid from 02/10/2025 - 02/10/2026 with James River Insurance Company (NAIC # 12203) - policy # #00140336-2. The one-story residential home consists of ten (10) resident bedrooms, two (2) resident bathrooms, living room, dining room, family room, kitchen, office area, washer and dryer/ storage area, backyard with table and chairs. Between the hours of 11:30am - 1:45pm, LPA conducted a records review of (7) client records, (5) staff records, (3) clients Personal & Incidental Records and reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (7) Client Medication Administration Records and did not observed any discrepancies at the time of visit. Between the hours of 12:05pm - 12:30pm, LPA Brown and Rommel Dungca toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature properly measured between 105 -120F (115.7F in Bathroom 1). The evaluation Report continues on the next page, LIC 809-C , providing further details of the inspection findings. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was observed and operational. Smoke detectors were working properly, fire extinguishers were fully charged, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards. During todays visit LPA did observe a deficiencies. Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8. See details below: 1. Medical Assessment 87458: Resident 5 (R5) and Resident 6 (R6) did not have TB Test Result on file at the time of annual inspection visit. 2. Maintenance and Operation Section 87303(f) - Standard: In Room 8 multiple gnats on cup filled with coffee inside and outside of the cup 3. General Food Service Requirements Section 87555(b)(27): In the kitchen near sink area, multiple gnats flying around. Note: *If citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. * An exit interview was conducted, and a copy of the Facility Evaluation Report with Appeal Rights was provided to Romina Ocampo (Direct Care Staff).