Routine inspection·July 17, 2025

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to conduct the annual required visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory clients with 1 hospice waiver. The facility currently has 3 clients with none on hospice. Divina Alipio has an Administrator Certificate expiring on 06/19/2026. Administrators David and Divina Alipio arrived during the visit. The facility appears clean and sanitary. LPA Lyman along with care staff Danny Garcia toured the facility at 8:23 AM. LPA toured the physical plant, checked food service, and reviewed facility documentation. The home consists of three client bedrooms, one shared hall restroom, client restroom, staff office, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client bathrooms were checked. Toilets and water faucets worked properly, and grab bars were secure. Water temperature measured between 110.4 and 112.6 degrees F in facility restrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including thermometer, tweezers and scissors as well as a first aid manual. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguisher is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating for clients. Exit gate is unlocked, self latching and operational. LPA observed ample emergency food and water supply as well as emergency packs for clients. LPA reviewed the emergency disaster plan as well as infection control plan during the visit. Plans are thorough and complete. Facility provided documentation of last fire drill conducted on 06/02/2025 and drills are conducted quarterly. CONTINUED ON LIC 809C DATED 07/17/2025 Facility provides activities in the form of games, exercise and outings in the community. At 9:00 AM, LPA reviewed two client files and three staff files. Client files contained required documents including admission agreements, physician reports and client appraisals. Staff files reviewed contained required documentation of health screens/ TB and criminal record clearance. Staff files reviewed contained CPR certification but not required annual training. LPA reviewed medication storage and administration. Facility uses a medication administration record. Medications are stored in a locked cabinet and are being administered per physician order. LPA reviewed P & I money with staff. Ledgers match cash on hand. Based on the observations made during today’s visit, deficiency is being cited per California Code of Regulations Title 22 Division 6. Exit interview conducted and a copy of this report as well as appeal rights were provided.