Routine inspection·September 28, 2025

On 09/28/2025, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual inspection. Upon arrival LPA met with staff Christyna Blanco. Later, the Administrator Tangonan Maria joined LPA and explained the reason for the visit. The facility has an approved fire clearance to be licensed to serve residents aged 60 and above, six (6) non-ambulatory, and (1) of which may be bedridden. Bedrooms 2 and 3 are allowed 1 non-ambulatory each. Bedroom 1 is allowed 2 non-ambulatory. Bedroom 4 is allowed 1 non-ambulatory and 1 bedridden. Hospice waiver approved for six (6). The facility is a single-story home: 4 bedrooms, 1 staff bedroom, 2 bathrooms, dining room, living room, kitchen, backyard, and an attached garage. Emergency disaster drill last conducted 09/09/2025. During today's visit LPA Richard toured the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (4) staff files, (6) resident files, medications, and medication administration records for (6) residents. All (6) resident bedrooms contained required furniture's, lamps, dresser, chair, and closet. Report Continued LIC9099C The two bathrooms contain a working toilet, basin, and water faucet, shower with grab bar, shower chair, and bath mat. The two bathrooms hot water temperature tested at 108.3F-108.5F. The smoke detectors were battery operated and individually tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (3) fire extinguisher located in kitchen, hall way, and garage fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured and locked in Kitchen cabinet. The cleaning agents and toxins were locked underneath kitchen sink. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. The outdoor grounds were toured and inspected, and the patio was well maintained with shaded seating area accessible for resident’s use. The garage contained cabinetry that contained emergency supply kits, bottled water, toiletries, personal care supplies, washer and dryer, toxins and cleaning agents stored locked and inaccessible to the residents. The entrance contained notifications and postings: California Labor Laws, Emergency Disaster Plan, personal rights, facility license, business license, medical emergency information, let-us-know licensing contact information, consumer grievance, support services, and community resources. Exit interview conducted. A copy of this report was provided to the Administrator Tangonan Maria Isabel.