Routine inspection·February 10, 2026

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Jennifer Leon, Administrator and explained the purpose of the visit. The facility is approved to serve residents age range 60 and over, (6) non ambulatory, of (1) may be bedridden designated to room #4. Hospice waiver approved for (6) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Operational Requirements: Plan of operation and training logs were reviewed. Th e facility accepts and retains residents with dementia. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place a nd expires 0 6/01/2026. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (7) bedrooms, (5) of which are resident bedrooms, (1) staff bedroom, (1) administrator/licensee room, (2) bathrooms, living room with covered fireplace, dining room, kitchen, attached garage, laundry area and backyard with patio area. There are currently (6) residents, (2) are under hospice care and (1) bedridden. The interior and exterior physical plant was inspected. Resident bedrooms were toured and each bedroom has the required furniture. Backyard was inspected and has a shaded area for outdoor activities. LPA observed a gardener working in the backyard installing water sprinklers during the visit. There are (2) fire extinguishers in the facility last serviced on 02/04/2025, however licensee, purchased a new fire extinguisher during the visit. Smoke detectors and carbon monoxide were tested and operable. There are no pools/ large bodies of water , firearms or weapons stored in the facility. The hot water temperature was measured between the required range of 105-120 degrees F. *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of (13) caregivers including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Four (4) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings. Administrator has completed the required administrator courses and certificate is valid through 08/08/2026.. Resident Rights-Information: Resident personal rights are posted. Facility provides internet services to all residents and have access to the facility phone. Administrator provides initial and ongoing training for staff. Planned Activities: Information regarding Dementia is part of training for direct care staff and is included in the Plan of Operation. The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Pesticides and cleaning supplies are kept away from the food preparation are as. (2) residents require modified/pureed diet. Incidental Medical Services: Residents' medications were reviewed during the visit. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are stored in a locked cabinet and inaccessible to residents. Resident Records-Incident Reports: (6) resident files w ere reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Emergency drill is conducted quarterly. Fire and earthquake drill was last conducted on 01/19/2026. Residents with SHN: (2) residents are under hospice care and (1) resident is bedridden . Physician order for full bed rail was reviewed on the (5) residents' files except for (1) bedridden re sident. There are no residents utilizing oxygen at this time. Deficiencies cited. Technical violation and Technical Assistance issued. Exit interview and a copy of this report along with the appeal rights were provided to the Administrator, Jennifer Leon.