Routine inspection·January 23, 2026

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six resident (5 non-ambulatory), of which one may be bedridden. As of today, the facility has three residents admitted to the facility. All of the residents were present during the visit. There’s a total of 5 bedrooms (4 resident & 1 staff) and 2 bathrooms areas for residents. There’s a living room space, a dining space, backyard and an attached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water was measured at 116.6 degrees F in both restrooms. Kitchen: 5 of 5 burners are operational on the gas stove. Sharps are kept locked in a cabinet under the counter. Cleaning chemicals are stored in a locked cabinet below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. Resident & Staff Files : Resident and staff files are stored in the locked filing cabinet in the garage. File Review: 3 of 3 resident files were reviewed during the visit, and 3 staff files were reviewed. Medications/First-Aid Kit: Resident medications are stored in the locked medication cabinet in the kitchen. A first aid kit was also observed mounted on the wall in the dining room. Medication Review: 3 of 3 resident medications were reviewed during the visit. Continued on LIC809C Linens & Hygiene Supplies: Hygiene and incontinent care supplies were observed locked cabinets in the main hallway. Plenty of additional linens were observed in the main hallway cabinets. Garage Area: The garage is organized and walkways are free of obstruction. There’s an office area with a desk and computer for staff. Emergency water was observed and a laundry with a washer and dryer. Soaps and cleaning solutions are in a cabinet above the washer and dryer. Backyard/Exterior: The backyard has a shaded patio area with a table and chairs. A locked storage space was observed on the side of the house. Incontinent care items and a wheelchair was observed. There’s a locked storage shed with a tools. Items no longer being used like bed frames, and an old sink was observed. Administrator was advised to removed the items and email LPA a photo of the backyard. A technical advisory will be issued. Bodies of Water: None. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted in the kitchen and in the garage. An emergency drill: An emergency earthquake drill was conducted November 18, 2025. Disaster drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Facility postings are posted are available for review on the main postings board at the entrance of the facility. Additional Comments: Licensing fees are current. Facility contact information was reviewed and updated during the visit. Deficiencies observed during the inspection will be cited. An exit interview conducted, and a copy of the report and appeal rights were provided