Routine inspection·September 23, 2025

On September 23, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Shimon Cagan was notified via telephone but could not arrive to assist with today's inspection. LPA observed that Shimon Cagan has a valid Administrator certificate which expires on November 21, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a single story home with four resident bedrooms, two of which can be shared, two shared resident bathrooms, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA, accompanied by a care giving staff, conducted a tour of the interior portions of the facility. On today's visit, there were four residents in care. LPA inspected the four resident bedrooms and observed them to be free of any hazards. Resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two shared resident bathrooms. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 108.1 and 108.8 degrees Fahrenheit. LPA observed the facility has a two day perishable and a seven day non-perishable food supply in the kitchen. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed kitchen appliances such as the refrigerator, stove, and microwave to be clean and operational. LPA observed fire extinguishers to be mounted on the wall in the kitchen and in the resident hallway. CONTINUED ON LIC809-C LPA observed fire extinguishers to be charged and serviced as of May 9, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the centrally stored medication to be kept in a locked closet. LPA observed a First Aid Kit to also be kept in the locked closet and it had all the required components. LPA observed the laundry room to be clear of any hazards. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to resident in care. LPA observed the garage to be used for storage. LPA observed chemicals and toxins to be kept in the locked garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by a care giving staff, conducted a tour of the exterior portion of the facility. The exterior was observed to be free of any obstructions of hazards. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed a fountain in the backyard which was adequately fenced for resident safety. LPA observed the exterior gate to be self latching and can be opened in an evacuation. LPA reviewed all four resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed residents' medication and medication administration records. LPA reviewed three staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with an authorized facility representative and a copy of the report was provided.