Routine inspection·March 19, 2026

On March 19, 2026, at 1:15PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Lourdes Manunay. Around 1:40 PM, LPA Kim spoke with Administrator (ADMIN) Mike Adams over the phone and explained the purpose of the visit. ADMIN Adams stated they could not attend today’s visit because they were out of the country and that CG Manunay could sign on behalf of the facility. LPA also spoke with ADMIN Adams about past due licensing fees and a current balance of $4947.00. ADMIN stated they will pay the Licensing Fee, but did not provide when. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for five (5) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) staff bedroom, three (3) bathrooms, living area, foyer, dining area, kitchen, outdoor covered patio, and a detached two car garage. The prior year, there was a walk-in closet next to the kitchen, but it was changed to be a second staff room. The facility sketch shows these two staff bedrooms were once one big staff room and that wall was not part of the original sketch. LPA Kim toured inside and outside of the physical plant with CG Manunay. There were no bodies of water and no physical obstructions in the passageways. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be clean and operational. Resident bathrooms hot water temperature measured between 98.4 degrees F to 100.0 degrees F. A comfortable temperature of 78 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C . LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in staff room #2. The facility has one (1) fire extinguisher that is charged and was not mounted in the kitchen. There is no service inspection date or receipt of purchase for the fire extinguisher. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A working telephone (714-870-5820) remains available. LPA Kim conducted an audit of resident files (R1-R4) and staff files (S1-S3). LPA observed R1's Appraisal Needs and Service plan was not signed and dated, and R2's Appraisal Needs and Service plan was last done on December 18, 2021. LPA observed R3 did not have a completed Physician's Report. There is a note that indicates that Kaiser refused to fill out the form. LPA did not observed 2026 staff annual training for S1-S2. The following observations were made: LPA observed there are two staff rooms at the facility, but the original facility sketch only shows one staff room. There is a wall added that was not reflected in the original sketch on file. The Fire extinguisher is not mounted and does not have an inspection service date or receipt. LPA Kim will address all of this in a subsequent visit. Due to time constraint a continuation of this inspection will be conducted at a later date. LPA will inspect all smoke and carbon monoxide detector, conduct an audit of the medication and medication administration record, staff interviews, resident interviews, a review of the evidence of liability insurance, audit of the emergency drill log, and audit of the first aid kit will be conducted. Deficiencies were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed R1's Appraisal Needs and Service plan was not signed and dated, and R2's Appraisal Needs and Service plan was last done on December 18, 2021. LPA observed R3 did not have a completed Physician's Report. There is a note that indicates that Kaiser refused to fill out the form. LPA did not observe 2026 Staff annual training for S1-S2. Resident bathrooms hot water temperature measured between 98.4 degrees F to 100.0 degrees F. The facility has a past due annual licensing fees for $4947.00 that has not been paid as of March 19, 2026. An exit interview was conducted, and a copy of this report, LIC811, and LIC809D, and appeal rights were provided to Caregiver Lourdes Manunay.