Routine inspection·October 27, 2025

At approximately 9:15 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Staff. Administrator Ana Bautista was called and arrived at approximately 9:45 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Facility has a Hospice waiver for three (3), with three (3) Hospice residents currently in care, and is approved for all non-ambulatory residents. At approximately 9:30 AM, LPA initiated a tour of the facility with Staff, Administrator arrived and took over shortly after, and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 10/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Sinks accessible to residents were labeled with signage warning of potential 125 degree F or higher water temperatures. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. During this visit, LPA observed a resident receiving an in-home dental visit and cleaning, per dentist this occurs approximately every four (4) months. There is a shaded seating area in the backyard with outdoor space for activities. Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. Continued LIC809C... Continued from LIC809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 9/25. LPA observed facility's infection control plan and emergency disaster plan which was last updated 9/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 10:30 AM LPA conducted a review of four (4) resident records. All required documentation present. At approximately 11:00 AM LPA conducted review of three (3) staff records. All required documentation present. At approximately 11:20 AM LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. Ana Bautista Administrator Certificate 7000300740 expires 3/12/2027. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : Liability Insurance LIC400 - Affidavit Regarding Client Cash Resources Updated copies of the following documents were gathered during this visit : LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.