Routine inspection·December 11, 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 Romualdo Amante was notified via telephone and could not assist in person There are currently five residents in care, three of which are receiving hospice care at this time out of a waiver capacity of two. Deficiency cited. Residents are observed relaxing in their respective bedrooms and in the common areas. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with four private and one shared bedrooms used by residents in addition to one staff room. There are two bathrooms used by residents. None of the residents are bedridden at this time. All occupied bedrooms appear clean and sanitary. There are four beds equipped with full rails or combined half-rails. Two residents have no orders on file. Citation issued. One resident not receiving hospice care also has a bed with full rails. Deficiency cited.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 two bathrooms with faucets used for personal grooming. 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 are verified to be secure. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Fire extinguishers are present and verified to be charged, however their maintenance tags are dated December 2022 and are therefore out of date. Type B deficiency cited. Carbon monoxide and smoke detectors are present and operational. LPA and facility staff toured the outside of the facility. LPA observed multiple shaded outdoor seating areas with outdoor furniture for resident use in the backyard. The identified routes of egress are 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 five resident records. LPA reviewed resident medication records and prescription orders with no discrepancies observed for four residents. LPA reviewed staff records for four staff members during the visit. All staff members on the schedule are background cleared and associated. Proof of current CPR training reviewed. Annual and initial training reviewed and found to be missing for staff member S1. Deficiency issued. Disaster drills are conducted quarterly. The administrator certificate is current. Based on the observations conducted during the present visit, five 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.