Routine inspection·August 29, 2025

At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Members, June Gallen Mateo and Cora Tuviera. Licensee/Administrator, Ana De Ventura arrived during visit at approximately 9:20AM. 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. Facility has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 6 Residents in care and 2 staff members on-site. At approximately 9:10AM, 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. LPA observed the following: Facility is a 1 story building with 6 Resident bedrooms, 3 bathrooms, and common spaces. Facility's office space located in facility backyard. 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. 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. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for all facility sinks were found to be within Title 22 regulations of 105F to 120F. Facility's fire extinguishers were last inspected July 2025. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted July 2025. During walkthrough, LPA observed that purchased food was appropriately labelled with dates but that homemade food did not have labels or dates. (technical assistance issued, LIC9102, regulation 87555(b)(8)). Licensee understands that all prepared foods must be labelled and dated appropriately. Continued on LIC809C Continued from LIC809 During visit, LPA was informed that facility now has live-in staff members and that they have been sleeping in the common areas of the facility on sofa beds. Licensee understands that space for live-in staff must be large enough to be comfortable and provide privacy (technical assistance issued, LIC9102, regulation 87307(a)). Licensee understands that if they plan to add or convert facility to have additional space that the proper permits must be obtained and a new facility sketch be provided to Community Care Licensing (CCL). 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. Residents had current assessments and care plans. Administrator Certificate for Ana De Ventura (7008504740) was shown to be current with an expiration date of 09/23/2027. LPA discussed the following topics with Licensee: Reporting Requirements PIN regarding 911 protocols PIN regarding dementia regulations Hospice Increase Request Per Licensee, they are wanting to increase their hospice waiver from 2 individuals to 3 individuals. LPA discussed regulation with Licensee. LPA to follow up on request. LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC308) Updated Lease/Control of Property Emergency Disaster Plan (LIC 610E) Updated Personnel Report (LIC 500) Updated Liability Insurance Active and Current Administrator Certificate Facility Documents to be submitted to Community Care Licensing (CCL) by due date of 09/29/2025. Exit interview conducted. Copy of report and LIC9102 (Technical Advisories/Violations) discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.