Routine inspection·August 14, 2025

On 08/14/2025, Licensing Program Analyst (LPA) V Gorban arrived unannounced to conduct Required Annual Inspection. LPA met with staff Rosalind Geronimo. Administrator (AD) Krystyl Sheen Ibanez was notified but did not attend the visit, certification number 6053811740 and expiration date 10/01/2025. LPA conducted facility tour inside and out of facility with staff. Residents observed at the facility before lunch time. The facility was observed to be at a comfortable temperature of 75 degrees, clean, in good repair, and no passageway obstructions or fire hazards observed. Fire extinguisher was observed with a service date of 07/30/2024. Recent fire drill recorded on July 07th, 2025 Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Food is delivered once a week. The facility is comprised of single level home. The census during the visit was 6 residents. Hot water temperature tested at 109 degrees F. LPA observed securely fastened grab bar and non-skid mat in shower area. The facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. Facility phone number observed operational 209-325-4444 Medications were stored in a locked medication closet in a common area. The first Aid Kit was observed with all required items. LPA reviewed facility Plan of Operation, Infection Control Plan, Emergency Disaster Plan and number of staff and residents’ files requested and reviewed during the inspection visit. LPA requested the following files: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, and updated Emergency disaster plan Deficiency cited during this visit on attached LIC809-D Exit interview conducted, report signed and copy of this report provided to staff for facility records