Post-licensing visit·September 19, 2025

On 09/19/25 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced, required, annual visit at the facility, being marked as post licensing visit. The facility is a Residential Care Facility for the Elderly, to serve the Elderly, for ages 60 and above. The capacity is for six (6) ambulatory residents of which one (1) may be bedridden. Structure: The facility is a four (4) bedroom, four (4) bathroom, single story house with an attached (2) car garage, located in a residential area. The facility is a white wood-paneled structure with (4) bedroom, (4) bathrooms, 1 living room, a restaurant style kitchen. The home has a gas fire place in the living room with a metal screen cover, and is inaccessible to clients. There is a large backyard, with a shaded patio area with plentiful seating for residents in care and a front yard with stable. The client bedrooms are spacious and will easily accommodate the client's furnishings. All walkways are either ramped or gated and there have been no obstructions observed during today's visit. All bedrooms have been approved for Ambulatory residents only, which shall not be used for Non-Ambulatory residents, per CCR 85087. Bedroom #1 is for bedridden residents . Bedrooms # three (3) and four (4) has two beds, two chairs, two night stands, two lamps in addition to overhead lighting and fan. Each room has more than 8 cubic feet of storage per resident. All bathrooms have a working toilet, wash basin, and a shower. Bathroom between rooms #(2) and #(3) has one walk-in shower which will accommodate non-ambulatory residents in a wheelchair. Each full-bathroom has a slip-resistant bath mat and all bathrooms host sturdy grab bars. Beds have the required linen/supplies which include, pillowcase, waterproof mattress pads, fitted sheet, draw sheet, and blanket. Bedspreads and ample linens are stored in the linen closet, located at the South-Western end of the house, closest to the stable. Report continues, please see LIC809C. The facilities telephone system is a landline and is in working condition. Posted & readily available for review in the entryway is the emergency disaster plan, which also displays emergency exit plan. Three (3) Fire Extinguishers are present in the facility with one (1) located near kitchen next to the fridge, one (1) in the entryway, and one (1) in the garage. Dishes, cups and flatware are stored in the kitchen cupboards, have been inspected and are in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer next to the sink. Food supply is adequately stored in kitchen cabinets and refrigerator. LPA observed at least a three (3) day perishable and seven (7) days non-perishable foods, adequately stored. There are three (3) twenty-five (25)-day emergency food is stored nearby the entrance and in the garage cabinet there is ample bottled water in case of emergency. Dishwasher in kitchen properly installed and in functioning condition, and all Smoke and Carbon monoxide detectors located in each room and are hard-wired. The alarm system has been professionally installed and have been tested during today's visit. Stove burners, oven, two (2) microwaves, washer, and dryer are in working condition. There is one refrigerator, measured at, at least, 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled. During today's visit, LPA observed a single resident (R1). This resident has been admitted to this facility on either the ninth (9th) or tenth (10th) of September. All required admission agreement and required medical assessment related to R1 were not available for LPA's review. LPA has decided these missing documents will be marked as a Technical Violation. Please see eleven (11) LIC9102TV's An exit interview was held with staff one, Lilibeth Bacani - Administrator, and a copy of this report and eleven (11) LIC9102TV's