Routine inspection·September 25, 2025

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Joyce Cornejo and the purpose of the inspection was discussed. Administrator (AD) Shelly Yamashiro was contacted by phone and arrived at approximately 10:00 a.m., however was unable to stay for the entirety of the inspection due to a private appointment and left at approximately 11:00 a.m. During the inspection, LPA and Staff Cornejo conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with four resident bedrooms, one staff room, two bathrooms, living room, dining room, kitchen, and attached two-car garage. In an unlocked kitchen cabinet, LPA observed staff’s own personal medication and supplements; a Deficiency was cited on today’s date. In the garage, LPA observed a bed, made with linen, blankets, and pillows, and staff's personal belongings, including clothing and shoes; a Deficiency was cited on today’s date. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents having lunch and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 158.3 degrees Fahrenheit; a Deficiency was cited on today’s date. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food a required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated September 16, 2025. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. (Cont. LIC809-C) Residents’ medication was observed to be centrally stored and locked. LPA conducted review of Medication Administration Records (MARs) and select residents’ medication. LPA reviewed five of five resident files and three staff files. LPA interviewed select residents and staff. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.