Routine inspection·September 12, 2025

Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit on 09/12/25 using the CARE Inspection tool. LPA was met by Staff #2 Jerome Unica and Staff #3 Gener Gutierrez and explained the purpose of the visit. S2 assisted in the tour of the facility and Administrator Rathay Suy arrived later during the facility tour. The facility is licensed to serve clients of age 18 to 59 years old clients and has a fire clearance approved for six (6) non-ambulatory of which one (1) may be bedridden and approved hospice waiver for three (3) clients. There were one (1) resident under hospice care. . A tour of the single-story facility began at approximately 9:10am that included residents’ rooms: one (1) private staff bedroom, four (4) bedrooms, two (2) bathrooms, living room, dining area, kitchen, backyard, garage/laundry room/storage space. All residents’ bedrooms have the required furniture for privacy, comfort, and safety. Additional bedding supplies and grooming supplies were observed in the hallway cabinets securely locked. Bedrooms #4 had an exit door. Bathrooms were observed clean and in good repair. Each is in working condition, showers were observed with grab bars and skid mats aside the wall. Water temperature was tested in each bathroom sinks measuring 125.0 degrees F - 125.2 degrees F., which is not within the required 105-120 degrees F. LPA observed the Infection Control Plan revised 06/26/25 and Emergency Disaster Plan revised 06/26/25. Last documented emergency drill conducted on 06/26/25. First Aid kit observed and (2) Fire Extinguishers were observed and last checked on 06/13/25. Carbon monoxide detector, smoke detectors, and auditory signal systems were in working order located throughout facility . LPA Madyun observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Madyun observed the emergency food supply in kitchen cabinet. LIC 809C for continuation of report. LPA observed the front and backyard to be clean and well maintained without any hazards. Due to windy weather conditions the provided shade covering was destroyed. The kitchen is in good repair, dishes and utensils were observed, the cabinets are used to store items for cooking. Refrigerators were observed clean and in good repair. Food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Water temperature was tested in the kitchen sink measuring 125.0 degrees F - 125.2 degrees F., which is not within the required 105-120 degrees F. The Laundry area was observed in the garage with locking cabinets for items that are inaccessible to clients. Licensing posters, Let us Know (PUB 745) and clients' personal rights were observed on a board in the kitchen/dining area. No large bodies of water were observed LPA Madyun observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Madyun observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. The medications are centrally stored in the medication cabinet securely locked and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. Resident files are maintained at the facility. LPA reviewed two (2) of six (6) clients medication logs. Due to time constraint LPA will return a later date and time for a continuation visit and conduct client interviews and review files and medication logs. Administrator Certificate for Shelly Yamashiro #7014120740 expires 10/05/27. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Staff files are maintained at the facility. LPA Madyun observed required annual training, CPR and First Aid for seven (7) out of the seven (7) personnel records reviewed. LPA Madyun observed TB testing results, Health scr eening, fingerprint clearance and job application for seven (7) out of the seven (7) personnel records reviewed. Due to time constraint LPA will return a later date and time for a continuation visit and conduct staff interviews. The following deficiency were cited according to The State of California Regulatory Codes, Title 22, Div. 6, Chapter 1(refer to Lic 809D). Exit interview conducted with Shelly Yamashiro and a copy of this report was provided.