Routine inspection·May 22, 2025

On May 22, 2025, at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Joko Encarnacion. Administrator (AD) Joey Encarnacion was out of town and communicated via telephone during the visit. AD Joey Encarnacion has an administrator certificate with an expiration date of April 14, 2026. The facility is a single level structure, licensed for six (6) non-ambulatory residents and has a hospice waiver for five (5) residents. The home consists of the following: Four (4) resident bedrooms, two (2) staff bedrooms, three (3) bathrooms, a living room area, den, dining room area, kitchen, outdoor shaded seating area, and an attached two car garage. During the visit, LPA Bentley toured the interior and exterior of the physical plant with CG Encarnacion and the following was observed: 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. Bathrooms were found to be clean and operational. The water temperatures in three bathrooms measured 109.5 degrees F to 114.9 degrees F. A comfortable temperature of 73 degrees F was maintained throughout the facility. LPA Bentley observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for cleaning supplies, toxins, and sharps objects were stored and locked. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available. CONTINUE TO LIC 809-C There is a two car garage with a refrigerator and additional supply of perishable items. The washer and dryer were observed to be in working condition. Facility has emergency food supply and water supply. The backyard was clean and free of clutter and debris. A shaded patio area with tables and chairs was observed. Emergency safety drills was last conducted on April 1, 2025 and conducted quarterly. First aid kit is maintained and contains all the necessary elements. Smoke and carbon monoxide alarms were tested and observed operational. A working telephone (714-481-0743) remains available, and the facility has a device that can be used for video teleconference purposes. The facility has two (2) fire extinguisher that was charged in the kitchen, laundry room and garage, all last serviced on April 16, 2025. Liability Insurance is effective June 5, 2024 through June 5, 2025. LPA Bentley conducted an audit of six (6) resident files (R1-R6), four (4) staff files (S1-S4), three (3) staff interviews, and three (3) resident interviews. A review of the Medication and Medication Administration Record (MAR) was conducted. Based on today’s observations, one Type A deficiency and two technical violations were cited during this visit 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, deficiency pages, and appeal rights were provided to Caregiver Joko Encarnacion .