Routine inspection·October 28, 2025

At approximately 9:05AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Licensee/Administrator, Pilar De Olave. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 5 residents, where 4 can be non-ambulatory. Facility has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 3 Residents in care and 2 staff members on-site. At approximately 9:15AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:45AM, LPA conducted a walk-though of the facility. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control Plan on file. Facility is a 1 story building with 4 Resident bedrooms, 2 bathrooms, and common spaces. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Fire extinguishers were last inspected April 2025. During walkthrough, LPA observed multiple instances of unlabeled homemade food in facility fridge (technical assistance issued, LIC9102, regulation 87775(a)). Facility's last emergency/disaster drill was conducted October 2025. At approximately 9:50AM, LPA reviewed resident files. All files were all found to be well organized, thorough and contained the required documentation. Administrator's Certificate for Pilar De Olave (6030062740) has been expired as of December 2021. LPA and Licensee discussed their expired Administrator Certificate. Licensee showed proof of completed CEUs and that paperwork was sent to the Application Bureau to complete their 2023-2025 renewal application by certified mail on 03/25/2025. Continued on LIC809C Continued from LIC809 Licensee agrees to submit their paperwork via the Application Portal and communicate with the Application Unit regarding their status. LPA and Licensee discussed hiring an Administrator until Licensee receives their renewed Administrator Certificate to help them maintain compliance with Title 22 Regulations (deficiency cited, LIC809D, regulation 87405(a)). LPA unable to complete Annual Visit. Annual Continuation Visit to be conducted at a later date. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D, LIC9102 (Technical Violation/Advisory), Plan of Corrections, and Appeal Rights discussed and provided to Licensee. Signature on form confirms receipt of documents.