Routine inspection·July 3, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by a caregiver and explained the reason for the visit. Administrator (AD) Nathan Lacson arrived shortly to assist with the visit. The facility is licensed for 6 non-ambulatory residents, with a hospice waiver for two. Currently there are three residents, of which one is on hospice during today's visit. LPA Tea reviewed three resident files and one staff file. There were discrepancies noted in the review of resident and facility files. There were no records of the emergency quarterly disaster drill. The administrator certificate is valid and expires on September 18, 2026. LPA Tea and administrator toured the facility at 2:09 PM. LPAs toured the physical plant, checked food service, and the first aid kit. The home consists of five resident bedrooms, two full bathrooms, living room, family room, dining room, kitchen and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 108.1 to 111.3 degrees Fahrenheit. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, dressing, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps not securely stored. Facility staff locked the sharps immediately after LPA address the issue. LPA also observed toxin substances underneath the kitchen sink not locked or secured properly. Facility staff locked up the toxins immediately Continuation of annual inspection on LIC809-C after LPA addressed the issue. The fire extinguisher in the kitchen is fully charged. Kitchen appliances are operational during today's visit except one stove burner was not properly lighting up. Administrator will clean and repair the burner stove. LPA toured the outside grounds and there is ample seating with shade and the two exit gates on both sides of the facilities are self-latching and operational. LPA observed emergency supplies, food and water in the garage. Facility provides activities based on resident interests and health condition. Residents sometimes watch TV in the family room area, they have board games for the residents. They try to do karaoke. The facility takes the residents outside. At the time of the visit, LPA observed residents resting in their rooms. At around 2:30 PM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the kitchen. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Nathan Lacson and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, 9102 and Appeal Rights.