Routine inspection·November 12, 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 caregiving staff after introducing himself and stating the purpose of the visit. Administrator Brian Estorba was notified and arrived shortly afterwards to assist. There are currently three residents in care, one of which is receiving hospice care at this time. Residents are observed relaxing in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with five bedrooms. There are two bathrooms used by residents, one of which is en-suite. None of the residents are bedridden at this time. All occupied bedrooms appear clean and sanitary. One resident uses half-length rails for postural support and one has full rails. Physician order for R1 and hospice plan of care for R2 reviewed during the visit. R2 only has an order for half-rails instead of full rails. Consultation provided. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are all equipped with grab bars and slip mats. Hot water temperature measured at 114F in the shared bathroom. Unsecured cleaning products observed under both bathroom sinks. Type A deficiency cited. 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 located in the kitchen and living room are verified to be secure. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Wall-mounted fire extinguishers are present and verified to be charged, however maintenance tags expired in May 2025. Type B deficiency cited. Carbon monoxide and smoke detectors were found to be present and operational. Emergency water supplies are stored in the garage. LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with outdoor furniture for resident use in the backyard. The identified route of egress is free of clutter and obstructions. There are self-latching gates on both sides of the premises. There are no bodies of water on the premises and the facility does not utilize either locked perimeters or delayed egress. LPA reviewed three resident records. The file for R1 did not show any completed reappraisal since 2022. Type B deficiency cited. LPA reviewed resident medication records and prescription orders with no discrepancies observed. LPA reviewed staff records for three staff members during the visit. One staff member (S1) present is found to have an incomplete background clearance application and is therefore not background cleared at this time. LPA requested the removal of S1 from the premises until the background clearance is issued. Type A deficiency and civil penalty cited and issued. Proof of current CPR training reviewed. Disaster drills are conducted quarterly. The administrator certificate is current. Based on the observation conducted during the present visit, two type A deficiencies and two type B deficiencies are being cited per Title 22 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.