Routine inspection·September 29, 2025

On September 29, 2025, at 1:45 PM, 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 (ADMIN) Cherry Aguila and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for six (6) residents. The facility is a two-story building located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) staff bedrooms, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio area, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Aguila. 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. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found clean and operational. The water temperature measured 121.6 degrees F to 129.3 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and 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. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the garage. 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 smoke detectors and carbon monoxide detectors were operable. A working telephone (714) 340-0754 remains available. First Aid kit had all the necessary elements. The facility has two (2) fire extinguishers that were charged, mounted in the living area and on the second floor next to the staff room that were serviced on September 4, 2025. Emergency drills are conducted quarterly and were last conducted on August 20, 2025. LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S3), and a medication and medication administration record that were all in order and complete. LPA Kim conducted interviews with one (1) staff and two (2) residents. A deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed hot water temperature in shared resident bathroom measured at 121.6 degrees F and resident room #1 bathroom measured at 129.3 degrees F An exit interview was conducted, and a copy of this report, LIC811, and appeal rights were provided to Administrator Cherry Aguila.