Routine inspection·October 27, 2025

On 10/27/2025 at 12:45pm, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one year inspection. LPA met with Jose Umana , Administrator and the purpose of the visit was discussed. The facility is licensed to serve 6 non- ambulatory of which 1 may be bedridden (bedroom #5 approved for bedridden) and approved for two (2) hospice waivers. The facility has four (4) of the residents are diagnosed with dementia, one (1) hospice, zero (0) home health resident and zero (0) bedridden resident. The facility does not handle any of the residents’ money. The facility has a current administrator Jose Umana has a certificate 7001004740 (valid 07/06/2025 - 07/05/2027). The last fire drill was conducted on 09/10/2025 The facility has liability insurance with James River Insurance Company (NAIC#12203) with an effective date as of 08/01/2025 - 08/01/2026 with each occurrence at $1,000,000 and general aggregate at $3,000,000 (Policy #001200934). The home is a single story home consisting of: (6) resident bedrooms, (4) full bathrooms, living room, kitchen with dining area, laundry room (located in the hallway) and an outdoor shaded patio area. Between the hours of 1:22pm - 3:00pm LPA reviewed (6) resident records, (6) staff records (1) Hospice Care Plan and and (6) Client Medication Administration Records. The last disaster drill was conducted on 09/10/2025. Report continues on LIC 809-C Between the hours of 12:55pm - 1:20pm, LPA Zina Brown conducted a toured with Jose Umana (administrator) the inside and outside of the facility. All client room were checked. Resident bedrooms had the required furniture had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at  118.5°F, 117.6 °F, 118.7°F . Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did observe deficiencies such as missing TB Test Results for Resident #4, missing LIC 503 Health Screening for Staff #4 and Physician Order for half-bed rails for Resident #2, Resident #3 and Resident #6. Citations were issued at this time. An exit interview conducted, appeal rights explained, and a copy of this report was provided.