Routine inspection·November 25, 2025

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. Upon arrival, LPA was greeted by Eugene Maglace, House Manager, and explained the purpose of the visit. Shortly thereafter, Administrator Assistant Maxson Raharuhi arrived at the facility. This facility is licensed to serve six (6) residents, age 60 and over, including six (6) ambulatory residents, of which two (2) may be non-ambulatory. Bedroom #3 is designated for non-ambulatory residents only. The facility has a hospice waiver for two (2) residents. During today’s inspection, there were three (3) residents receiving hospice care. Facility Tour & Observations Personal Rights postings (LIC 613C and Ombudsman), the Complaint Poster (PUB 475), and the nondiscrimination notice were observed in a common area and accessible to residents. Residents had access to personal space, privacy, and adequate storage throughout the facility. No firearms or weapons were observed on the premises. “No Smoking – Oxygen in Use” signs were posted on applicable bedroom door s. Physical Plant The facility is located in a residential neighborhood and is a one story home consisting of three (3) resident bedrooms, one (1) bathroom, a living room, kitchen, dining area, attached garage, front yard, and backyard. Each resident bedroom contained the required furniture, including a bed, mattress, linens, dresser, chair, and appropriate lighting. **Continue of 809C** Cleaning supplies and other toxic substances were observed to be inaccessible to residents, stored in a locked kitchen cabinet and in the locked garage. The bathroom was clean and equipped with the required grab bars in the shower and near the toilet, as well as non-skid mats. Hot water measured 107.9°F , which is within the required regulatory range of 105–120°F . Extra linens and towels were available in the hallway closet. Smoke and carbon monoxide detectors were tested and found to be functional. A fire extinguisher was available in both the kitchen and the garage. No bodies of water were observed on the premises. The backyard provided shaded seating for residents. All passageways and exits were clear and unobstructed at the time of the visit. Food Service Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. Health-Related Services & Records Three (3) resident files were reviewed. Files contained Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, and Rights Acknowledgments. However, Physician’s Reports (LIC 602A) and TB test results were missing from the files reviewed , which does not meet Title 22 record keeping requirements. Three (3) residents’ medications were reviewed; medications were centrally stored in a locked cabinet. MAR logs were observed to be current. Disaster Preparedness No fire or earthquake drills were conducted, and no drill logs were available for review. The LIC 610D Emergency Disaster Plan was posted in the living room bulletin board. Emergency supplies including water, food, flashlights, batteries, and a first aid kit were observed in the garage. The facility’s Infection Control Plan was updated. **Continued on 809C** Insurance Liability insurance was in compliance with an expiration date of March 12, 2026. An exit interview was conducted with , Maxxson Raharuhi Administrator Asst,. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. The Administrator's Assistant was advised of the nature of the deficiencies, the regulatory basis, and the required Plan(s) of Correction (POC). The Administrator Assistant agreed to submit proof of correction by the due dates specified. A copy of this report, the LIC 809D/809C, and Appeal Rights will be provided via email.