Routine inspection·January 16, 2026

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Joann Hernandez, Caregiver 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 six (6) non-ambulatory residents. The facility is approved to retain no more than four (4) residents receiving hospice care. There were four (4) residents under hospice care during inspection and two (2) residents receiving home health. Facility Tour & Observations Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Oxygen was observed in use in the facility. Required “Oxygen in Use / No Smoking” signs were posted throughout the facility in visible locations. 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 six (6) resident bedrooms, two (2) restrooms with one being a private restroom, living room/dining area, kitchen, laundry room, garage, front yard, and backyard w/a gated pool. LPA observed six (6) resident bedrooms, and all contained the required furniture (bed, mattress, linens, dresser, chair, and lighting). (continued 809C) 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) 105.2°F and bathroom (2)105.3 which is within the required 105–120°F. Extra linens and towels were available in a hallway cabinet. Smoke/carbon monoxide detectors were functional; fire extinguisher available by front entrance and dining room area. 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 (R1–R6) were reviewed. All six (6) files were missing Annual Appraisals. Five (5) residents had current Admission Agreements; however, R5 did not have an Admission Agreement on file. Pre-Placement Appraisals were complete for four (4) residents; R5 and R6 had incomplete or missing Pre-Placement Appraisals. Consents, Needs/Service Plans, and Physician’s Reports documenting TB clearance and ambulatory status were present for three (3) residents. Residents R3, R5, and R6 did not have TB test results on file; additionally, R5 did not have a Physician’s Report. Resident Rights acknowledgments were present for all residents. Three (3) residents’ medications were reviewed and observed to be centrally stored in a locked kitchen cabinet. Medication Administration Records (MARs) were current. Disaster Preparedness Last fire/earthquake drill was conducted on November 26, 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) staff files were reviewed and included criminal record clearances. CPR/First Aid certificates were missing for two (2) staff members (S1 and S3). TB screenings were missing for three (3) staff members (S2, S3, and S4). Required training documentation was reviewed and present. Insurance Liability insurance was in compliance with an expiration date of April 5, 2026. An exit interview was conducted with Toby Miclat, Administrator. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C and Appeal Rights was provided via email.