Routine inspection·April 24, 2026

On April 24, 2026, at 8:45 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 Irvin Harris Mendoza and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory, of which one (1) may be bedridden and have a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, four (4) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Mendoza. There were no bodies of water or obstructions in the facility. 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. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. LPA observed R1’s room and R2’s room both have a postural support attached to their bed. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 108.5 degrees F to 113.7 degrees F. A comfortable temperature of 73 degrees maintained in the facility. 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. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. LPA Kim observed the facility to be 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. Emergency food, emergency water, and emergency supplies are stored in the garage. A working telephone (714-602-8845) and an internet accessible device dedicated to the residents that can do video teleconference which both remain available. Last emergency drill was conducted on March 31, 2026. First aid kit is maintained and contains all the necessary elements. The facility has two (2) fire extinguishers which are located and mounted in the dining area and the resident hallway. Both extinguishers were last serviced on January 9, 2026. Evidence of liability insurance is effective April 5, 2026, and expires on April 5, 2027. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S6), and medication and medication administration record. LPA Kim observed there is no physician order for the postural support for R1 and R2. LPA Kim conducted interviews with 2 staff. A deficiency was cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed R1 and R2 have a postural support attached to each of their beds without a physician’s order. An exit interview was conducted, and a copy of this report, LIC809D, LIC811, and appeal rights were provided to Administrator Irvin Harris Mendoza.