Routine inspection·July 28, 2025

On July 28, 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) Raul Reyes and explained the purpose of the visit. The facility is licensed to operate for five (5) non-ambulatory residents, one bedridden resident, and has a hospice waiver for two (2) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living room, office area, dining room, kitchen, detached 2-car garage, and outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with ADMIN Reyes. There were no obstructions or bodies of water 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. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 118.5 degrees F and 119.1 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. 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. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and 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, water, and supplies are stored in the garage. The facility has four (4) fire extinguisher that are charged and mounted in the kitchen, entrance, laundry area, and end of the hallway. All smoke/carbon monoxide detectors were operable. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA Kim observed the PUB475 poster measured at 8.5” by 13”. The facility conducts Fire/Safety Drill quarterly and was last conducted on April 30, 2025. A working telephone (714-340-3341) remains available. The facility does not have an internet accessible device with videoconferencing technology dedicated to residents. First Aid Kit contained all the necessary elements. The facility did not have a current Certificate of Liability Insurance. LPA conducted an audit of two (2) resident files (R1-R2), four (4) staff files (S1-S4) and medication and medication administration record that were all in order and complete. LPA Kim conducted one staff interviews. A deficiency was cited during the visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). The facility did not have current and active liability insurance for the facility. Technical Violations were assessed during the visit. PUB475 poster measured at 8.5” by 13” and the facility did not have an internet accessible device dedicated to residents. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Raul Reyes.