Routine inspection·November 21, 2025

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual visit. LPA was greeted by staff and the purpose of the visit was explained. Administrator Paul Shay and Caregiver Jade Robles arrived shortly after to assist with facility tour. The facility is licensed to serve six (6) non-ambulatory residents ages 60 and above. One (1) resident may be bedridden. The facility may retain six (6) hospice residents. The facility is a single-story home located in a residential area of Glendora. The home consists of the following: five (5) bedrooms, two (2) bathrooms, kitchen, dining area, receiving room, TV room, attached garage with laundry area, and backyard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environmental Safety: The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded area located in the backyard with sufficient seating for residents in care. Passageways and exits are free of obstructions. The water temperature was tested in bathroom #1 in the hallway and measured 110.1 degrees F, which is within the required 105 degrees F - 120 degrees F. Bathroom #2 water temperature measured 106.8 degrees F. LPA observed grab bars and non-skid mats in both the bathrooms. continued on LIC 809C continued from LIC 809 (page 2) Resident bedrooms all have required furniture which includes, for each resident, a bed, a chair, nightstand, and lights sufficient for reading. Resident beds have the required linen and linens were observed to be in good repair. There is closet storage space for clothing and other belongings.Hallway cabinet contained PPE supplies, surplus hygiene supplies and extra, clean linens. Smoke detectors were observed throughout the facility and are operable. There is a carbon monoxide detector located in the hallway, was tested and is operable. There are three (3) fire extinguishers located near the kitchen, garage and by back door. Emergency drills conducted quarterly, last drill conducted 10/3/25. All kitchen areas observed clean and free of litter, rodents, vermin and insects. Kitchen appliances such as refrigerators, stove and microwave are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are secured, inaccessible to residents. Cleaning supplies and disinfectants are secured under the sink and are inaccessible to the residents and separate from food supply. Sufficient supply of 2 days perishable and 7 days non-perishable foods were observed. Containers storing waste are in good repair and free of leaks.Telephone service on the premises Fireplace located in receiving room and TV room were observed to have covered screens, inaccessible to residents. Dining area and living room are clean and free of obstructions and have sufficient seating for residents in care. Attached garage has laundry area. Washing machine and dryer wear clean and operable at the time of visit. There is a cabinet with laundry supplies, cleaning supplies and excess PPEs. There is also a refrigerator and freezer with overflow of food supply. Staffing: Administrator and two (2) staff CPR training expired October 2025. Staffing sufficient in number and competent to meet resident need. LPA observed training logs for all staff. continued on LIC 809C (page 3) Personnel Records- training: LPA reviewed files for four (4) staff. Personnel record maintained for each employee to contain the following: criminal record clearance, first aid/CPR, fingerprint clearance, personnel record, health screening, TB test Residents Rights: Personal Rights are posted and observed in client files Planned Activities: LPA observed board games and books for resident use. Resident Records/Incident Reports: LPA reviewed five (5) resident files. Each file contained admission agreement, recent medical assessment, TB clearance, ambulatory status, medical consent form, identification/face sheet, appraisal needs and service plan, personal rights. Medications are centrally stored in the secured kitchen pantry. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Residents with Special Health Needs: Home health services provided for R4 to assist with G-tube Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were cited during today’s visit. Exit interview held and a copy of this report was provided to Administrator Paul Shay.