Routine inspection·May 4, 2026

On May 4, 2026, at 1:45 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 Administrator Ron Wilkes and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory, of which two (2) can be bedridden and has a hospice waiver for four (4) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: six (6) residents bedrooms, one (1) staff bedroom, eight (8) bathrooms, an attached 2-car garage, living area, dining area, kitchen, and an outdoor covered seating area. LPA Kim toured inside and outside of the physical plant. There are no bodies of water or obstructions 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, resident room 5, and resident room 6. Bathrooms were found to be clean and operational. The water temperature measured between 111.9 degrees F and 115.9 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. 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 Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). 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 the pantry. All mandated inspection control posters were posted. The facility has smoke detectors and carbon monoxide detectors that were operable. The Certificate of Liability Insurance is effective from July 11, 2025, to July 11, 2026. The facility conducted a Fire/Safety Drill on May 4, 2026 and were conducted quarterly. One (1) fire extinguisher was mounted in the resident hallway last inspected on September 9, 2025. A working telephone (714-594-3638) and video conferencing internet device dedicated to the residents both remain available. First Aid Kit contained all the necessary elements. LPA Kim conducted an audit of six (6) residents (R1-R6) files, and four (4) staff (S1-S4) personnel files, and medication and medication administration records that were all in order and complete. LPA conducted interviews with two (2) residents and one (1) staff. No deficiencies were cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. A technical violation was assessed during the visit. LPA observed emergency drill log was last conducted on May 4, 2026, and were done quarterly from 2025 to 2026. An exit interview was conducted, and a copy of this report was provided to Administrator Ron Wilkes.