Routine inspection·September 4, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. The Licensee (LE) Francis Mejia arrived shortly to assist with the visit. The facility is licensed for 6 non-ambulatory residents with a hospice waiver for six, in which one may be bedridden. Currently there are five residents, of which three residents are on hospice during today's visit. LPA Tea reviewed five resident files and two staff files. Resident files and staff files contained all the required documentation. One minor issue, residents had the wrong Personal Rights form on file. LPA advise the facility the correct form, LIC613C. Facility acknowledge the issue and will update the resident files with the correct forms. The last quarterly Emergency disaster drill was last conducted on June 24, 2025. The administrator’s certificate expires on May 23, 2026. LPA Tea along with facility staff toured the facility at 9:51 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 4 resident bedrooms, 1 staff room, 2 bathrooms, living room, family room, dining room, kitchen, and a garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured around 119.3 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards; doorways were free of obstructions. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected. The kitchen has been (Annual Inspection Report continued on LIC809-C) recently renovated. The supply of perishable and non-perishable food supply was checked and adequately stocked at the time of the visit. LPA observed sharps locked in the drawer. LPA also observed toxin substances to be locked and inaccessible to residents underneath the kitchen sink and outside in the storage cabinet. The fire extinguishers throughout the facility hallways were fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating underneath a shaded patio area in the backyard. LPA notice unused items that the facility no longer uses in the backyard. LE Mejia will have them removed as soon as possible. The items do not pose as a hazardous risk to residents in care nor obstructing any pathways. There are two exit gates that are self-latching and operational on both sides of the house. LPA observed emergency food and water stored in pantry cabinets in the family room and garage. Facility provides activities based on their health conditions and personal preferences. Residents walk around the facility grounds. There is an activities person that comes to do musical therapy. At the time of the visit, LPA observed residents watching television. LPA reviewed medication storage and administration. Medications are stored in a locked storage closet by the dining room. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Licensee Francis Mejia and a copy of this report LIC809, along with the 809-C, LIC858, LIC858-C, LIC859, were read and provided to the facility.