Routine inspection·December 18, 2025

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 (S1) at 8am. LPA met with Administrator (AD) Karl Padua and explained the purpose of the visit. The facility is a six- bedroom, two-and-a-half bathroom, single story home with a fire clearance for six non-ambulatory residents and hospice waiver approved for six residents. The facility currently has a census of six residents in care and four residents on hospice. During today's visit, LPA toured the facility and tested carbon monoxide and smoke detectors and both were operational. LPA observed a video camera in the common area that does not have audio. LPA observed the fire extinguisher was charged and inspected on November 3, 2024. The facility conducted their last fire drill on December 12, 2025. The facility was clean and there were no odors detected. LPA inspected the kitchen and all of the stove burners are in working order. Cleaning chemicals and disinfectants were secured beneath the sink and knives/sharps were secured in a drawer. The refrigerator had the required two day perishable items and the pantry had seven days of non-perishables on-hand. Fruits were observed on the counter and, at time of the entry, residents were eating breakfast. Emergency water was in the garage. While touring the interior LPA observed the PUB 475 posted, as well as Personal Rights, Resident Council information and Visiting Hours. LPA tested two of two resident bathroom water temperatures. The hot water temperatures ranged between 105.3 to 108.1 degrees Fahrenheit. Showers had grab bars and non-skid (Continued on LIC 809-C) (Continued from LIC 809) mats and all disinfectants were secured. LPA toured resident rooms and noted they had the required furnishings of tables, chairs and beds. Bed rail orders were observed on file and all linens were clean and there was an ample supply of linens in hallway closet. LPA toured the exterior of the property and observed the exterior gates were unlocked. There was ample space for residents to walk outside and the bird bath and water fountains were empty for the winter months. LPA observed a shaded seating area and there were no hazards obstructing pathways. After breakfast, LPA observed three residents doing chair exercise and listening to music. LPA reviewed three of three staff training and fingerprint records. and conducted a complete review of resident records . LPA observed medication storage and reviewed the centrally stored medications. Per review of Medication Administration Records, medications are being given as prescribed. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on November 16, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Karl Padua, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.