Routine inspection (multi-day)·October 9, 2025

At approximately 09:20 AM, Licensing Program Analyst (LPA) Star Stevenson returned to CONTINUE the annual required inspection and met with caregiver Nerica "Janela" Rosales and responsible party (RP) who called Licensee Francisco "Kit" Roa who explained that he would not be available for today's continued inspection and gave permission for Nerica Rosales to assist. LPA observed that the threshold in main bathroom has been repaired with tape removed and tripping hazard removed. At approximately 9:45 AM LPA reviewed five (5) of five (5) resident files and found two (2) of five (5) missing records, as well as, one (1) of (5) missing evidence of MD/X-ray TB clearance. With resident one (R1) missing an Admissions Agreement (LIC604), Consent for Emergency Medical Treatment (LIC627C), Appraisal Needs and Service (LIC625) and Signed Personal Rights (LIC613C) and Resident two (R2) missing missing Physician TB clearance or chest X-ray indicating free from TB (two Type B deficiencies issued) Medicines were observed to be centrally stored and lock and medicine administration and records were observed to be accurate. Continued on LIC809C Continued from LIC809 Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/06/2025 1)Current Lease Agreement or evidence of Control of Property 2)Updated LIC308- Designation of Responsibility 3)LIC500- Personnel Report 4)Updated LIC610E- Disaster Plan 5)Updated Evidence of 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. This report was reviewed with Nerica "Janela" Rosales and Appeal rights were given