Routine inspection·October 17, 2025

Licensing Program Analyst (LPA)s Vaid and Mallett conducted an unannounced annual inspection visit. LPAs met Ronie Culala-caregiver who allowed entry into the facility, Ralph Estanislao, Administrator notified. LPA explained the purpose of the visit. The facility has a capacity of six (6) to serve residents from age 60 and above which may have six (6) non-ambulatory and three (3) hospice waivers. Two (2) residents are on hospice. Administrator certificate is current, and expiration date is 03/17/2027. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. The facility is a single-story house located in a residential neighborhood consists of three (3) shared bedrooms, two (2) bathrooms, open living room, dining room next to the kitchen, laundry room, outdoor patio and a storage shed in the backyard. No garage. Staff area next to laundry room, inaccessible to residents. Residents' bedrooms have dresser, chair and closet space available. Adequate linen and personal hygiene supply are observed. Adequate linen and personal hygiene supplies. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. The kitchen is clean and has maintained the required food for two (2) days perishable and seven (7) days non- perishable. Appliances are in working condition. Hot water temperature was in a range of 105-120 degrees Fahrenheit which was within Title 22 Regulation guidelines. continued on LIC 809 C………………….. Dual combo of smoke and carbon monoxide detectors are operable. Fire extinguishers are fully charged last inspected 10/02/2025. Auditory devices are operable. The first aid kit is fully stocked. Mandated documents and signages are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication is centrally stored. Medication Administration records are incomplete -citation issued. Resident records are stored in a locked storage room and inaccessible to residents. Liability Insurance expires 2/14/2026. All staff CPR /AED expires 9/03/27. Deficiency is cited per California Code of Regulations, Title 22, Division 6, Chapter 1. Personnel Requirements 80065(a) An exit interview was conducted. Report is discussed, signed and provided to facility staff. 809, 809C, 809D with appeal rights.