Routine inspection·September 26, 2025

On September 26, 2025, at 9:00 AM, 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 (ADMIN) Karl Padua and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents 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: five (5) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio area, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Padua. There were 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. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be clean and operational. The water temperature measured 127.2 degrees F to 127.8 degrees F. A comfortable temperature of 74 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. Emergency food, emergency water, and emergency supplies were stored 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). All mandated inspection control posters were posted. The PUB 475 poster measured at 13”x19”. The smoke detectors and carbon monoxide detectors were operable. A working telephone (562-296-8800) and laptop with videoconferencing technology both remain available. First Aid kit had all the necessary elements. The facility has one (1) fire extinguisher that was charged, mounted next to the staff bedroom that was serviced on November 23, 2024. Emergency drills are conducted quarterly and were last conducted on September 20, 2025. Evidence of liability insurance was effective from March 11, 2025, to March 11, 2026. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S2), and medication and medication administration record that were all in order and complete. LPA Kim conducted interviews with one (1) staff and one (1) resident. A deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). Hot water temperature in bathroom #1 measured at 127.5 degrees F, bathroom #2 measured at 127.2 degrees F, and bathroom #3 measured at 127.2 degrees F. A Technical Violation was assessed during the visit. PUB475 measured at 13”x19”. An exit interview was conducted, and a copy of this report, appeal rights, and LIC9102 were provided to Administrator Karl Padua.