Routine inspection·September 19, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Glenda Lopez and stated the reason for the visit. Administrator (Admin) Richard Mendoza arrived on premise to assist with the inspection. The administrator's certificate for Richard Mendoza is valid expiring on June 12, 2026. The following was observed during the inspection: This is a single story property located in a residential neighborhood comprised of six private resident bedrooms and two resident bathrooms. Facility operates within the conditions and limitations specified on the license. LPA observed six residents in care of which one resident is receiving hospice service. LPA observed two caregivers on duty and verified fingerprint clearance and association statuses including the administrator. All common areas were inspected which includes the laundry room and attached two car garage. LPA toured the interior portion of the facility. LPA observed and inspected the six private resident bedrooms. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. All bathrooms were found be in compliance, clean, and operational. The hot water temperature in both bathrooms measured at 109.4 and 113.9 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. The fireplace is barricaded by the sofa. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The two exit gates on each side of the property were operational, and there were sufficient seating and shading in the patio area. The fire extinguishers were mounted, charged, and serviced on August 25, 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency food/water and supplies in the kitchen. The first aid kit had all necessary elements. Emergency drills were conducted on September 5 & 10, 2025. The required Complaint Poster (PUB475) poster was posted in the entry way in the size of 16.75" x 26." LPA reviewed six out of six resident files and two personnel files in which discrepancies were found in the resident files as five out of six residents did not have an updated medical assessment after a change in condition. Three out of those five residents, facility did not maintain record for the Tuberculosis (TB) testing. There were no bed rail orders for three out of six residents as well as no needs and services plan for the current year in five out of six residents. Additionally, facility did not have documentation of the current medication list for five out of six residents. Medication was audited for one out of six residents since the only medication list was available for Resident #2 (R2). The following was addressed during the visit: to ensure the medical assessments are updated annually, to complete the needs and services annually, to ensure facility maintains documentation of TB test results, to obtain bed rail orders, to maintain a complete and current medication list, to replace the two toilet seat covers, to ensure the PUB475 meets the size requirement required per regulation, and to maintain/organize complete staff/resident records. Based on the observations made during today's visit, deficiencies are being cited. Advisory Notes are also being issued. An exit interview was conducted with Administrator Richard Mendoza, and a copy of this report including the Confidential Name (LIC11) and the appeal rights were provided at exit.