Routine inspection·November 21, 2025

On November 21, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted the facility administrator (AD) Maria Jimenez about the visit. For this visit, there are two staff members on duty, both of which are background cleared and associated. AD later arrived to assist with the inspection. The PUB475 ‘See Something, Say Something’ poster was observed to be located in the dining room. LPA observed the Administrator's Certificate for Maria Jimenez, which expires on April 20, 2027. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, none of which may be bedridden, and hospice waiver for two. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of six non-ambulatory residents in care, two of which are on hospice, and none are bedridden. The facility is a single-story home. There are a total of six bedrooms, three are three resident bedrooms, and three staff bedrooms. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff bedrooms to be kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of two and a half bathrooms, one and a half bathrooms are for residents and one is for staff. Continued on LIC 809-C. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathrooms were measured to be between 105.4 and 109.9 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen cabinet and inaccessible to residents in care. Fire extinguisher was mounted and located in the kitchen. Fire extinguisher needs to be charged and was purchased on January 17, 2023. LPA observed the emergency disaster and evacuation plan, which is posted in the hallway. LPA observed the facility conducted their last emergency disaster drill on February 2, 2025. Facility had back-up emergency food and water supply, located in the garage. LPA observed that the First Aid kit had all the required components. Medications were observed to be locked in a storage room in the hallway. Toxins were observed to be locked in the laundry room, inaccessible to residents in care. LPAs observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. The garage is used for storage and the emergency food is kept in the garage. For the exterior portion, LPA observed patio furniture under shading. There are two exit gates in the backyard that can be opened in case of an emergency. There is a shed in the backyard which is locked and used for storage. There is a pool in the backyard with a secured fence around it. During this visit, six resident files and three staff files were reviewed. All staff are background cleared and associated with the facility. LPA reviewed residents’ medication and medication records and two resident interviews were conducted. Based on today's observations, there are two deficiencies being cited per Title 22 of the California Code of Regulations. There are two technical violations (TV). An exit interview was conducted with Maria Jimenez. This report was reviewed with the administrator and a copy was provided at the end of the visit. Appeal Rights were reviewed.