Routine inspection·October 9, 2025

On October 9, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by facility administrators (AD) Rosa Reyes and Johan Mathews. For this visit, there are two staff members on duty, both are background cleared and associated. The PUB475 ‘See Something, Say Something’ poster was observed to be located by the kitchen. LPA observed the Administrator's Certificate for Rosa Reyes, which expires on April 11, 2026. The facility is a Residential Care facility for the Elderly (RCFE) licensed for four residents, four of which may be non-ambulatory, none of which may be bedridden, and a hospice waiver for four. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of four non-ambulatory residents in care, two of which are on hospice, and none are bedridden. The facility is a two-story home. There are a total of five bedrooms, two of which are shared resident rooms on the first floor, and three as staff bedrooms on the second floor. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of three bathrooms, one is for residents on the first floor and two are for staff on the second floor. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathroom was measured to be 111.0 degrees Fahrenheit. Continued on LIC 809-C. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. Fire extinguisher was dated and tagged on July 8, 2025. LPA observed the emergency disaster and evacuation plan, which is posted in the hallway of the first floor. Facility had back-up emergency food and water supplies located in the garage. LPA observed that the First Aid kit had all the required components. Medications are locked in the kitchen cabinet and toxins were observed to be locked in the garage, inaccessible to residents in care. A fireplace in the living room was kept covered. For the exterior portion, LPA observed patio furniture under overhead patio shading and umbrella. The grounds were free of any hazards or obstructions. There is one self-latching gate in the backyard that can be opened in case of an emergency. A body of water was observed in the backyard with appropriate fencing surrounding it. During the annual inspection, interviews were conducted with two residents. Four resident files and four staff files were reviewed during today's visit. LPA reviewed medications for all four residents. Two sets of medications were dated with incorrect start date of November 3, 2025. Based on today's observations, there is one deficiency being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Johan Mathews. This report was reviewed with the administrator and a copy was provided at the end of the visit. Appeal Right were reviewed.