Routine inspection·April 6, 2026

On April 6, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purposes of conducting a required 1-Year annual visit using the CARE Inspection Tool. LPA Bentley was greeted and granted entry by staff, after stating the reason for the visit. Administrator (AD) Clara Han was contacted by telephone, unable to be present during the visit, and designated Caregiver Florentino "Jesse" Pedralvez to sign the report. The facility is licensed to operate forage range 60 and over, for six (6) non-ambulatory elderly residents, with a Hospice Waiver for four (4). The building is a single story structure located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, an outdoor covered seating areas, and an attached two car garage. During the inspection, LPA Bentley toured inside and outside of the physical plant with staff. There were no obstructions on the premises. A comfortable temperature of 73 degrees F was maintained in the facility. LPA observed the facility to be appropriately furnished at the time of visit and free of clutter and debris. 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 and available at the time of visit. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available. Bathrooms were found to be clean and operational. The water temperatures in bathrooms measured at 111.9 degrees F to 117.0 degrees F. Continues on LIC 809-C…. The first aid kit is maintained and contains all the necessary elements. Smoke alarms and carbon monoxide detectors were operable. Emergency food, emergency water, and emergency supplies were available. The facility has one (1) fire extinguisher that was charged, mounted, and serviced on April 1, 2026. Liability Insurance is effective July 1, 2025, and expires on July 1, 2026. A working telephone (714-968-4909) remains available, however the facility does not have a device that can be used for video teleconference purposes. A Technical Violation was provided. The facility last conducted an emergency safety drill on March 26, 2019 and a deficiency was cited. During the visit, LPA conducted an audit of six (6) resident files (R1-R6), three (3) staff files (S1-S3), and medication and medication administration records. A total of three (3) resident and two (2) staff were interviewed. Based on today’s observations, a deficiency was cited, as per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report, LIC809-D, Technical Violation, and appeal rights were provided to at the end of the visit.