Routine inspection·October 27, 2025

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Margie Isidro and explained the purpose for today’s visit. The facility is licensed to serve 6 Ambulatory Adults Age 60 and over, (2 of which may be non-ambulatory in Room #1, 1 non-ambulatory in room #2, 2 non-ambulatory in room #3, and 1 ambulatory). There is a Hospice waiver for 2 residents. The facility is a single-story home located in Bellflower, Ca. A tour of the facility includes: 4 bedrooms (2 of which are vacant), 2 full bath (1 full bath is inside room #1), 1 1/2 bath, living room, dining area, kitchen, attached garage with laundry, front yard and back yard. There is an ADU in the back yard that Administrator resides in, there are no residents living in ADU. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit observed the following: Infection Control: Facility maintains the required Infection Control Plan. Operational Requirements: There's an approved fire clearance and maintain the required liability insurance. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Residents with Special Health Needs: There currently are no residents on hospice at the facility. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Last fire/earthquake drill was conducted on 9/18/25. (Continued on LIC809-C) Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested throughout the facility and measured outside the required range of 105-120 degrees F, restrooms water temperatures ranged from 90.8-100.8 degrees F (citation issued and details will be documented on LIC809-D page) . All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. Staffing : There are currently 2 staff for facility, Administrator stated since there are only 3 residents with little care needs there is no need for additional staff, LPA advised Administrator that additional staff may need to be hired if more residents are admitted to meet their needs. Personnel Records-Training : Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in postural supports, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 2 staff files with no issues observed. Administrator Margie Isidro has a valid certificate that was verified through the CCL website with an expiration date of 2/2/26. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. Although residents have their initial appraisal and physician reports, Resident # 1's last Appraisal is dated 2/29/24, Resident # 2's last complete physician report is dated 8/15/24.(citation will be issued and documented on the LIC809-D page) Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a locked cabinet. LPA reviewed 2 residents’ medications and observed the following. LPA observed Resident #2 was missing 2 medications that are listed on the Medication list and there were other medications stored in basket that are not listed on medication list, for Resident #3 there were 4 mediations listed on the doctors medication list that were not at the facility, also LPA noticed facility is using medication pill box Sun-Sat with pills inside the Wed/Thurs slots. (812 with details of medication and residents names provided, citations will be issued and detailed on LIC809-D page). Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during todays visit will be documented on LIC809-D. Exit interview held and a copy of the report and appeal rights were provided to Margie Isidro.