Routine inspection·December 19, 2025

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met Administrator Buenomir Mirabueno explained reason for visit. The facility is licensed to serve 6 non-ambulatory residents age 60 and over, of which 1 may be bedridden in room #2. Facility is approved for 6 hospice waivers. The facility is in a residential area, and it is a one-story family home. A tour of the single-story facility included the 4 resident bedrooms, 1 staff room, 2 bathrooms, living room, kitchen, laundry room, attached garage, front yard and back yard. LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. Extra linen was observed in hallway storage cabinet. The Smoke detectors and carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has one (1) fully charged fire extinguishers which is kept in kitchen area. Cleaning supplies and toxic substances were observed to be inaccessible in a locked cabinet in laundry area, knives were locked in kitchen cabinet. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 7 days non-perishable foods and enough 2-day perishable foods for six (6) residents. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms was not measured between the required range of 105-120 degrees F. The resident bathrooms have the required grabs bars and non-skid mats. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents in backyard. Passageways and exits are free of obstruction. SEE LIC 809C Four (4) staff files were reviewed and included criminal clearance record, and health screening with TB. Staff did not have additional 20-hour annual training. Three (3) out Five (5) resident files were reviewed and included physician reports and appraisal needs and service plan. Two (2) residents files did not have updated physicians reports along with one resident did not have a TB test result. Fire drill was conducted in November of 2025. The medications are centrally stored and locked in a cabinet in kitchen cabinet. LPA reviewed medications for three (3) residents, and they are being administered as prescribed by the physician. Mar log is being used. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was deficiencies observed during the visit (Refer to LIC 809-D). Exit interview held and a copy of the report and appeal rights were provided.