Routine inspection·December 2, 2025

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Maria Heidi Baquiran and explained the reason for the visit. Max Raharuhi, Administrator Assistant arrived shortly thereafter. The facility is licensed to serve residents ages sixty (60) and older. The approved capacity is five (5) non-ambulatory residents and one (1) bedridden only. This facility may retain no more than two (2) hospice residents. There were four (4) 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. Physical Plant The facility is in a residential area and is a one-story home consisting of five (5) resident bedrooms, one (1) restrooms, living room, kitchen, dining area, laundry room, garage, front yard, and backyard. LPA observed five (5) resident bedrooms, and all contained the required furniture (bed, mattress, linens, dresser, chair, and lighting). Cleaning supplies and toxic substances were accessible to residents in a kitchen cabinet under sink. Bathrooms were clean and equipped with required grab bars in showers and near toilets, as well as non-skid mats; hot water measured in bathroom (1) 115.2°F which is within the required 105–120°F. Extra linens and towels were available in a hallway cabinet. **Continued on LIC809C** Smoke/carbon monoxide detectors were functional; fire extinguisher was located by the front entrance. There were no bodies of water present. Backyard provided shaded seating. Passageways and exits were observed to be clear 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 Six (6) resident files were reviewed. Files contained Admissions Agreements, Pre-Placement Appraisals, Consents and Rights Acknowledgments. However, TB test results were missing from the files reviewed, which does not meet Title 22 record keeping requirements. Four (4) residents’ medications were reviewed and two (2) out of four (4) residents had unprescribed PRN’s; medications were observed to be centrally stored in a locked hallway closet. MAR logs were observed to be current. Disaster Preparedness Last fire/earthquake drill was conducted on October 19, 2025, with logs available. LIC 610D Emergency Disaster Plan was posted on kitchen bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training Four (4) files were reviewed and included criminal record clearances, two (2) out of four (4) files did not have updated CPR/First Aid training, required annual trainings and three (3) out of (4) did not have TB screenings. Insurance Liability insurance was in compliance with an expiration date of April 5, 2026. An exit interview was conducted with Kevin Ortiz Lead Caregiver. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. Kevin Ortiz Lead Caregiver was advised of the nature of the deficiency, the regulatory basis, and the required Plan of Correction (POC). Mr. Ortiz agreed to submit proof of corrections by the POC due dates specified. A copy of this report, LIC 809D/809C, and appeal rights will be provided via email.