Routine inspection·September 26, 2025

On September 26, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Nilusha Abeysinghe. LPA explained the purpose of today’s visit. The facility is licensed to operate for six non-ambulatory elderly resident ages 60 and above. The facility is approved for two (2) hospice waiver. Currently, there are no hospice resident in care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) residents' rooms, two(2) staff room, two (2) bathrooms, one (1) staff bathroom, a living area, a dining area, a kitchen, and an outside patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A water temperature of 105.0 degrees F. A comfortable temperature was maintained in the facility 77 degrees F. LPA observed the facility to be sanitary and appropriately furnished during the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained adequately. The fire extinguishers were charged, and smoke detectors and carbon monoxide were operable. A review of Medication Records Administration (MAR) was observed to be maintained in order. The facility has a current liability insurance effective 11/17/24 – 11/17/25 policy #0100336011-0 Evaluation Report Continues on LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed staff followed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. Posters mandated for inspection control were posted. An audit of residents #1-#3 (R1-R3) service records and staff #1-#4 (S1-S4) personnel records. The facility is current on CCL annual dues. The facility has a current Administrator Certificate for Nilusha Abeysignhe #7022740740 effective: 07/07/2024 through 07/06/2026. Deficiencies: During file review of service records for Resident #1 and Resident #3, LPA observed medical records for both resident hospitalization for 10/09/24 and 05/06/25, and current plumbing issues to CCLD not reported. LPA identified Resident #2 with full bed rails is not on hospice care and did not have physician's order for full bed rails. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D). An exit interview conducted with Nilusha Abeysignhe, and a copy of the report is provided. Note: *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) are cleared. *