Routine inspection·August 4, 2025

On August 4, 2025, at 1:30 PM, 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 met with House Manager (HM) Rosallie Gabriel. A phone call was attempted to Administrator (AD) Juhayna Diaz. ADMIN Diaz did not respond and who could not attend today's visit. HM Gabriel signed on behalf of the facility because ADMIN Diaz was absent from August 1, 2025, to August 4, 2025.. The facility is licensed to operate for six (6) non-ambulatory residents and have a hospice waiver for four (4) residents. The facility is a two-story building located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, five (5) staff bedrooms, six (6) bathrooms, living room, family area, dining room, office, kitchen, attached 2-car garage, and 2 outside covered patio areas. LPA Kim toured indoor and outdoor of the physical plant with HM Gabriel. There are no obstructions or bodies of water on the premises. 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. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Staff Room 1, Staff Room 2, Staff Room 3, Staff Room 4, and Staff Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. Bathroom water temperature measured between 107.6 degrees F and 108.1 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and 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. LPA observed the left side burners were covered and the knobs had child safety locks on them. The Licensee was not present for the LPA to test if the burners were operable. Emergency food, water, and supplies are stored in the kitchen pantry and in the garage. 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). The facility conducts Fire/Safety Drills quarterly and was last conducted on June 1, 2025. A working telephone (714-312-0054) remains available. Smoke detectors and carbon monoxide detectors were operable. LPA audited resident files (R1-R4). LPA observed appraisal from R1 dated 11/25/2023, R2 dated 3/24/2024, and R4 did not have any appraisal on file. LPA observed medical assessment from R1 dated 11/29/2023 diagnosed with dementia, and R2 dated 6/26/2023 who is diagnosed with dementia. Due to time constraints a continuation of this inspection will be conducted at a later date. LPA Kim will: 1) conduct record review for staff, 2) Conduct interviews with staff and residents, 3) Inspect First Aid Kit, 4) inspect device with internet access dedicated residents, and 5) conduct a medication review at a later date. Based on today’s visit, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of California Code of Regulations (CCR). LPA observed appraisal from R1 dated 11/25/2023, R2 dated 3/24/2024, and R4 did not have any appraisal on file. LPA observed the auditory devices for the front entrance, vacant resident room, and backdoor exit were not in working order during the visit. Technical violations were assessed during the visit. LPA observed medical assessment from R1 dated 11/29/2023, and R2 dated 6/26/2023. LPA observed the left side burners covered and with child proof safety locks at the knobs. LPA observed the LIC308 does not designate the house manager when Administrator is absent. An exit interview was conducted and a copy of this report and appeal rights were provided to House Manager Rosallie Gabriel.