Routine inspection·August 25, 2025

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Kevin Mendoza and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 8:15AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 6-bedroom, 3-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 3 staff and 6 residents present at the facility in addition to AD. Resident Bedrooms: the 6 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested below 120 degrees F in the 3 bathrooms, after corrections. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. LPA discussed the facility’s licensing fees with AD. At about 9:30AM, LPA reviewed 6 resident files and 4 staff files, interviewed 2 residents and 2 staff, and inspected medications for 6 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on observation, the water temperature tested at 128 degrees F in the private resident bathroom in the master bedroom and 140 degrees F in the private resident bathroom near the kitchen; based on observation, the licensee does not have nightlights in the common resident bathroom and the bathroom in the master bedroom and the overhead lights turn off automatically; based on observation and documents, the licensee did not ensure Staff #1 (S1) and Staff #1 (S2), who LPA confirmed are both background cleared, were associated to the facility as they have been working here for at least two years; based on documents, the licensee did not ensure Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), and Resident #4 (R4) were reassessed within the last year; and based on documents and admission, the facility has only conducted one emergency disaster drill in 2025. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.