Routine inspection·April 1, 2026

At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required visit and met with Staff Member, Nancy McKee. Licensee, Tina Camaclang, arrived during visit at approximately 10:40AM. Facility provides care and assistance to older adults and has a dementia care program on file. Facility has an approved fire clearance for a total capacity of 12 non-ambulatory residents. Upon arrival, LPA was informed that there were currently 8 residents in care and 3 staff members on-site. At approximately 9:10AM, LPA reviewed the Facility's Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation. LPA conducted a walk-through of the facility and made the following observations: Per facility sketch, facility consists of 8 resident rooms, a staff break room, and common areas. Facility has a separate building for laundry and extra storage. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. 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. Toxins and other hazards were observed to be stored inaccessible to residents. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Mattress pads were in place or available for Resident use. Hot water temperatures for all facility sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. During walkthrough, LPA observed the following: Multiple instances of food being unlabelled in facility fridge Facility freezer in need of cleaning - observed frozen liquid and food particles at the bottom of freezer drawer. During visit, LPA observed facility staff put dates on unlabelled foods and clean the freezer drawer of liquid and food particles. Continued on LIC809C Continued from LIC809 Prepoured noon medications for two residents observed on kitchen counter and additional prepoured bedtime medication found in locked medication cabinet for multiple residents LPA observed that a kitchen cabinet door was not attached leaving the facility pots and pans exposed, and a resident's toilet lid and seat was not fastened to the toilet Resident bathroom wastebins did not have lids on them LPA observed that staff break room was being used as additional storage and had multiple bags and other boxed items Facility did not have emergency water supply on-site LPA observed that facility's last documented emergency/disaster drill was conducted December 2025. Per Licensee and facility staff, they had an emergency drill in March 2026 but were unable to provide documented proof of drill. Facility's emergency disaster plan was last reviewed and updated 12/2025. Facility's smoke and carbon monoxide detectors were tested and operational. LPA observed that facility's fire extinguisher was newly purchased per receipt stating 03/2026. LPA reviewed 4 staff files. Staff Files were all found to have current First Aid and CPR certification. 2 of 4 staff files were shown to not have a health screening or negative TB test on file. 1 of 4 staff files showed that Staff Member 4 (S4) was hired by the facility on 10/01/2025 but had their health screening and TB test done on 12/12/2024. Per Title 22 Regulations, a health screening shall be completed no longer than 6 months prior to their employment. Administrator's Certificate for Albertina Camaclang (7002848740) was current with an expiration date of 02/16/2028. LPA reviewed 4 resident files. Resident files had updated assessments and reappraisals. 2 of 4 residents had missing consent forms. 1 of 4 residents did not have their appraisal signed. During walkthrough, LPA observed that Resident 1 (R1) had full bed rails. Review of R1's file showed that R1 has been receiving hospice services since 2025 but did not have a care plan or hospice care plan on file indicating if there was an order or specified need for their full bed rails. LPA conducted a spot audit of 3 Resident medications. LPA observed the following errors: Facility was not completely filling out medication expiration dates and was only documenting month and year instead of month, day, and year as shown on the pharmacy label. Error in filling out expiration and fill dates per pharmacy label Continued on LIC809C Continued from LIC809C Clearlax medication was labelled as "Over the Counter" or OTC, when it had a pharmacy label for the facility to document on the LIC622 or Centrally Stored Medication and Destruction Record Facility had some resident medication that was not logged as required. LPA is requesting the following documents to update facility file: Designation of Facility Responsibility (LIC308) Updated Personnel Report (LIC500) Updated Liability Insurance 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 (Deficiency Page), LIC9102 (Technical Advisories/Violations), Plan of Corrections, and Appeal Rights discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.