Routine inspection·January 21, 2026

***This is an amended Annual Report originally completed on 01/21/2026 under an incorrect facility. Licensing Program Analyst (LPA) conducted a case management visit on 01/28/2026 to create and deliver the annual report reflecting this facility.*** Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Christian Reyes; Caregiver explained the reason for the visit. Deborah Davis, Administrator/Licensee, arrived shortly thereafter. This home is licensed to serve 6 residents ages 60 and over, six (6) non-ambulatory of which two (2) may be bedridden. Facility has a hospice waiver for six (6) residents. There were two (2) residents under hospice care during inspection. Facility Tour & Observations: Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. “No smoking - Oxygen in Use signs” in various locations of the facility. Physical Plant The facility is located in a residential neighborhood and consists of a single-story home. The home includes five (5) resident bedrooms, one (1) caregiver bedroom, and three (3) bathrooms, of which one (1) is a private bathroom and one (1) is designated for visitor use. The facility contains a large, combined living room and dining room area, an additional living room, kitchen, dining area, attached garage, front yard, and a large backyard. (continued on 809C) The front yard includes a long driveway with a walkway leading to the front entrance. A fenced swimming pool is located on the left side of the home. Each resident bedroom was observed to contain the required furnishings, including a bed with mattress, linens, dresser, chair, and adequate lighting. Cleaning supplies and toxic substances were stored under the kitchen sink and were observed to be locked and inaccessible to residents. A Hoyer lift was observed in R1’s room; per the Caregiver, the lift is used only as needed. Bathrooms were observed to be clean and equipped with required grab bars in the showers and near toilets, as well as non-skid mats. Hot water temperatures measured within the required range of 105–120°F, with readings as follows: Bathroom (1) 105.3°F, Bathroom (2) 109.9°F, and Bathroom (3) 119.0°F. Extra linens and towels were available and stored in the hallway closet. Smoke and carbon monoxide detectors were tested and found to be functional. Two (2) fire extinguishers were observed and accessible near the resident’s bedroom area. The backyard provided shaded seating for residents. All passageways and exits were observed to be clear, safe, and unobstructed. Food Service: Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. Health-Related Services & Records: Five (5) residents files were reviewed and contained current required documents Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports with TB/ambulatory status and Rights acknowledgments. Four (4) residents’ medications were reviewed; medications were observed to be centrally stored in a locked hallway cabinet. MAR logs were observed to be current. Disaster Preparedness: Last fire/earthquake drill was conducted on December 23, 2025, with logs available. LIC 610D Emergency Disaster Plan was posted in the living room area. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training: Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Deborah Davis was valid through January 15, 2027. Insurance: Liability insurance was in compliance with an expiration date of March 06, 2026. An exit interview was conducted with Romeo Lumasag , Caregiver. During the inspection, the facility was observed to be following Title 22, Division 6 regulations. No deficiencies were cited at this time. A copy of the report was provided.