Routine inspection·October 6, 2025

On October 6, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Assistant Administrator (AA) Rodolfo Domingo was present and assisted on today's inspection. LPA observed that Rodolfo Domingo has a valid Administrator certificate which expires on December 13, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, and has a hospice waiver for four. The facility is a two story house with six private resident bedrooms located on the first floor, two resident bathrooms, two staff bedrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the AA, conducted a tour of the interior portions of the facility. On today's visit, LPA observed six residents in care and two care giving staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall in the dining room. LPA inspected the six private resident bedrooms and observed them to be free of any hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the two residents bathrooms and observed them to be free of any hazards. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 104 to 105.3 degrees Fahrenheit. LPA inspected the two staff bedrooms, one of which is located on the first floor and the second is located on the second floor. LPA observed staff bedrooms are kept locked and inaccessible to residents in care. CONTINUED ON LIC809-C LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed a fire extinguishers to be mounted on the wall in the kitchen and it was observed to be charged and serviced as of November 4, 2024. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on September 15, 2025. LPA observed the centrally stored medication to be kept in a locked medication cart stored in the dining room. LPA observed the facility also has a First Aid Kit stored in dining room and it had all the required components. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the two car garage to be used for storage and laundry. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the AA, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gates of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with Assistant Administrator Rodolfo Domingo and a copy of the report was provided.