Routine inspection (multi-day)·August 12, 2025

Licensing Program Analyst (LPA) Daniel Konishi conducted the unannounced required annual inspection. LPA met with the caregiver, Arney Manseguiao and the purpose for the visit was explained. Shortly after the House Manager, Rudy Ignacio arrived and LPA explained the purpose of the visit. This home is licensed to serve the age range 60 and over. Six (6) non-ambulatory only. Hospice waiver for six (6). The initial annual visit was conducted on 07/31/2025. During the initial visit the following six (6) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant Environmental Safety, Resident Rights-Information, Planned Activities, Food Services, and Disaster Preparedness. During today’s annual visit, the following six (6) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Operational Requirements, Staffing, Personnel Records-Training, Resident Records-Personnel Reports, Incidental Medical and Dental, and Resident with Special Health Needs. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation and maintains the required liability insurance in place. Staffing : There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in the care and supervision of the residents in the case of an emergency. Personnel Records-Training : LPA observed four (4) staff files which include: health screening, TB test results, personnel records, criminal record clearance, current First-Aid/CPR/AED training, medication assistance, dementia, and other ongoing training are documented in personnel files. Administrator’s Certificate Expires on 04/28/2027. However, Staff #2 (S2’s) file did not have a health screening. Resident Records-Incident Reports: Resident files are kept in a secure location. LPA reviewed six (6) resident files which included the Face Sheet, Identification and Emergency Information, Physician’s Report, ambulatory status, TB test result, Pre-admission appraisal/Appraisal Needs & Services Plan, Preplacement appraisal, Admission Agreements, Personal Rights. Based on record review, LPA observed Resident #6 (R6’s) file did not have an updated medical assessment. Based on record review, LPA observed that Resident #2 (R2) and Resident #3 (R3’s) file has a physician’s report that has a Dementia diagnosis that is over a year old. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. LPA reviewed six (6) residents’ medications and there were no issues observed. Residents with Special Health Needs: There are no bedridden or residents with postural support at this facility. There are no residents with prohibited and restricted health conditions. There are three (3) residents that receive hospice care. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the House Manager, Rudy Ignacio.