Routine inspection·September 4, 2025

At approximately 12:55PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Administrator, Justine Herrera. 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 total capacity for 6 non-ambulatory residents of which 1 may be bedridden. Facility has an approved hospice waiver for 4 individuals. Upon arrival, LPA was informed that there were 6 Residents in care and 2 staff members on-site. At approximately 1:10AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Administrator and observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility is a 1 story building with 6 Resident bedrooms, 3 bathrooms, and common spaces. Facility had emergency lighting. Facility had an Infection Control plan on file. 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. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected July 2025. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted June 2025. LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. Administrator's Certificate for Justine Herrera (7027363740) was current with an expiration date of 10/23/2027. Continued on LIC809 Continued from LIC809 LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC308) Emergency Disaster Plan (LIC610E) Updated Personnel Report (LIC500) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 10/04/2025. No Deficiencies Cited during Visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.