Routine inspection·June 9, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility administrator Susan Cambio after stating the purpose of the visit. There are currently three residents in care, none of which are receiving hospice care at this time. LPA observed residents relaxing in the facility's common living areas with visitors or in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a two-story house with a loft used exclusively for staff accommodation, along with an attached garage. The facility has two shared and two private bedrooms along with one staff room on the ground level and two shared bathrooms, one of which is en-suite from one of the rooms. Bedrooms appear clean and sanitary. No residents are observed using postural supports at the time of the visit. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 108F and 110F in two separate bathrooms equipped with faucets used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secured. The wall-mounted fire extinguisher is charged. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The garage is inaccessible to residents and used for laundry as well as additional storage of food and supplies. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with furniture for resident use. There is one self-latching gate on one side of the property and a double-wide gate on the other side of the property. The routes of egress are free of clutter and obstructions. There are no bodies of water on the premises. Facility does not utilize locked perimeters or delayed egress. LPA reviewed three resident records. Two resident records are found to be incomplete for two recently admitted residents. Admission agreements, pre-admission appraisals and individual needs assessments are found to be missing. Type B deficiency cited. LPA reviewed resident medication records and prescription orders for all residents with no discrepancies observed. Oxygen is not currently in use on the premises. There is one resident currently assessed as being bedridden at the time of the visit per their physician report. Resident is however able to reposition independently and is regularly placed in a wheelchair. Facility staff instructed to request an updated form LIC602 accurately reflecting the resident's condition. LPA reviewed staff records for two caregivers present during the visit. Present staff members have current CPR certificates on file. Incomplete initial and annual training observed on file. Type B deficiencies cited. Disaster drills are conducted however no proof of attendance is currently being generated. Type B deficiency cited. Both staff members present are background cleared. Both staff members are however not associated to the present licensed location. Type A deficiency cited. Based on the observations made during today’s visit, one type A and seven type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.