Routine inspection·October 7, 2025

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to Assistant Administrator Danielle Maximo. The facility serves elderly residents ages 60 and older whom are developmentally disabled. The facility is licensed as a level 4 RCFE vendored by San Gabriel/Pomona Regional Center. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed and includes environmental cleaning and disinfection activities. Facility has sufficient Personal Protective Equipment. Operational Requirements: A hospice waiver for 4 residents is approved. A fire clearance was granted for 4 non-ambulatory residents. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 6/20/2026. Facility handles resident P & I monies. The Surety bond expires 2/8/2028. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood consisting of 4 private resident bedrooms, 2 bathrooms, living room, dining room/kitchen, outdoor patio area with patio furniture, and 2 car detached garage with laundry area. Smoke and carbon monoxide detectors were tested and are operational. The facility has one (1) fire extinguisher. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances are inaccessible to residents. The last Emergency Disaster drill was conducted on 10/4/2025. Bedroom #3's mini blinds are in disrepair/torn and bedroom #2’s door that exits to the side yard has a gap on the left side of casing/door closure area. Staffing: A total 6 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 7/20/2026. Staff have criminal background clearance and training. Six (6) staff files were reviewed. Proof of continuing education/staff training, health clearance, and 1st Aid/CPR training is current. Resident Records/Incident Reports: Four (4) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent, and Medication Administration records. R1'R4's Physician Reports are incomplete. RCFE and Ombudsman complaint posters are posted in the facility. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council due to cognitive impairment of residents. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. One (1) resident requires a modified diet. Incident Medical and Dental: Centrally stored resident medications were reviewed. 30-day supply of medications was observed. Medical and dental transportation is provided by facility staff. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: No residents receive hospice care or home health services at this time. No residents have prohibited health conditions. Two (2) residents are currently at a higher level of care facility. Pursuant to Title 22, deficiencies were cited. An exit interview was conducted with Assistant Administrator Danielle Maximo. A copy of the report and appeal rights was issued.