Routine inspection·October 7, 2025

Licensing Program Analyst’s (LPA’s) Christian Gutierrez, and Elena Mallett conducted the required annual inspection. LPA’s arrived unannounced and met with Phyllis Lee - Assistant Administrator and explained the purpose for today’s visit. The facility is licensed to serve 6 Non-Ambulatory Residents ages 60 and over (dementia approved), with a Hospice waiver for 2. There are no Residents with Hospice services at the moment. The facility is a single-story home located in Lakewood, Ca. A tour of the facility includes: 4 resident bedrooms, 1 bathroom, living room, kitchen, laundry area, front yard, and backyard. There is a separate area for staff that includes bedroom, living room, 1 staff bathroom, washer/dryer, and a staff office area with a surplus of canned foods/refrigerated food and washer and dryer. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. LPA’s observed full bed rails for one (1) resident not on hospice care. Smoke detector in bedroom #4 was not working at time of visit. No carbon monoxide detectors were observed in facility. The facility has three (3) fully charged fire extinguishers. Cleaning supplies and toxic substances are inaccessible locked in closet and under kitchen sink. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grab bars and non-skid mats. The hot water temperature in the bathrooms were not measured between the required range of 105-120 degrees F. The common areas, including the living room and dining area, are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in front yard. Passageways and exits are free of obstruction. LPA’s observed garage to be converted into bedroom for staff deficiency cited. SEE LIC 809C Three staff files reviewed included criminal clearance record, health screening with TB, three (3) out of three (3) staff did not have valid CPR/First Aid. Five (5) out of six (6) resident files reviewed and did not have updated physicians’ reports, R3 and R4 were missing appraisal needs and service plans. No fire/earthquake drill was available. Infectious control plan was reviewed. Six (6) resident medications were reviewed. Medications are centrally stored and locked MAR log is used. 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 was held and a copy of the report along with appeal rights will be emailed due to printer problems.