Routine inspection·August 26, 2025

Licensing Program Analysts (LPA) Christian Gutierrez conducted an unannounced annual visit at the facility using the CARE Tool. LPA Gutierrez met with Elvira David (Administrator) and explained the reason for the visit. The facility is licensed to serve 6 residents over the age of 60, four (4) non-ambulatory and approved for two hospice waivers. The facility is operating within the scope of its license. tour of the single-story facility included: kitchen, dining area, living room, 3 resident bedrooms, 3 bathrooms, laundry room, backyard, and attached garage. LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. The Smoke and carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has two (2) fully charged fire extinguishers which are kept in kitchen, and living room. Cleaning supplies and toxic substances were observed to be accessible in unlocked cupboard in laundry area. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 2 days perishable & 7 days non-perishable foods. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The residents’ bathrooms have the required grab bars and non-slip mats for residents. Clean towels and extra clean linen were observed bedroom cabinet. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents in backyard Passageways and exits are free of obstruction. There is extra food and supplies in garage. SEE LIC 809C Three (3) staff files were reviewed and included criminal clearance record, and health screening with TB. Four (4) resident files were reviewed and included physician’s reports and appraisal needs and service plan. Fire/earthquake drill was conducted August 4th, 2025. The medications are centrally stored and locked in a cabinet closet in dining room. LPA reviewed medication for all 4 of the residents and observed that medications are documented properly and given as prescribed. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview held and a copy of the report along with appeal rights were provided.