Routine inspection·September 13, 2025

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual visit. LPA was greeted by staff and the purpose of the visit was explained. Administrator Tiffany Vander Poorten arrived shortly after to assist with facility tour. The facility is licensed to serve six (6) non-ambulatory residents age 60 and over with a hospice waiver for six (6). The facility is a single-story home located in a residential neighborhood of Glendora. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded area located in the backyard with sufficient seating for residents in care. Passageways and exits are free of obstruction. There was a broken door on the side of the house, licensee arranged for disposal with local waste management. The water temperature was tested in bathroom #1 in the hallway and measured 117 degrees F, which is within the required 105 degrees F - 120 degrees F. Bathroom #2, in a resident bedroom, water temperature measured 122 degrees F, licensee was monitoring water temperature and will adjust accordingly. LPA observed grab bars and non-skid mats in both the bathrooms. continued on LIC 809C continued from 809 Smoke detectors were observed throughout the facility and are operable. There is a carbon monoxide detector located in the dining area and laundry room of the home. There were fire extinguishers located near the kitchen, laundry and garage which are charged. Last emergency drill way conducted July 2025. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are inaccessible to residents. Cleaning supplies and disinfectants are locked under the sink and are inaccessible to the residents. Sufficient supply of 2 days perishable and 7 days non-perishable foods were observed. Dining area located in the kitchen was clean and had sufficient seating. Fireplace located in the family room and sitting/visitor area had required covered glass screen doors. Living room and sitting/visitor area were clean and free of obstructions and have sufficient seating for residents in care. Medications are centrally stored in a cabinet in the living room. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Resident bedrooms have all require furniture which includes, for each resident, a bed, a chair, night stand, a lamp, or lights sufficient for reading. Bed linens were clean and in good repair. There is closet space for clothing and other belongings. Hall closet contained extra clean linens. Four (4) resident and four (4) staff files were reviewed and were observed to contain required documentation. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were cited during today’s visit. Exit interview held and a copy of this report was provided.