Routine inspection·September 25, 2025

On September 25, 2025, at 8:00 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 (ADMIN) Uldarico Almiranez and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents of which one (1) may be bedridden and have a hospice waiver for four (4) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) staff bedroom, 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. 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, Resident Room 5, and Resident Room 6. LPA Kim observed there was a bed setup with curtains to provide private space for staff member. A staff member was sleeping in the garage one time per a week. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measure 118.0 degrees F to 118.9 degrees F. A comfortable temperature of 76 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. LPA observed the lock under the kitchen sink was not working and contained a 102 FL oz bottle of Palmolive and 155 oz bottle of Cascade. 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 staff bedroom was missing a smoke detector, but all other smoke detectors and carbon monoxide detectors were operable. A working telephone (657) 845-4355 remains available. First Aid kit had all the necessary elements. The facility has one (1) fire extinguisher that was charged, mounted in the kitchen that was serviced on March 20, 2025. Emergency drills are conducted quarterly and last conducted on September 5, 2025. Evidence of liabilityInsurance is effective October 13, 2024, to October 13, 2025. LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S5), and medication and medication administration record. LPA observed R1's Reappraisal dated 3/18/2022 , R2's Reappraisal dated 1/5/2023, R3's Reappraisal dated 5/20/2022, and R4's Reappraisal dated 5/28/2022. LPA Kim conducted interviews with two (2) staff and two (2) residents. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed a bed that staff were using to sleep on in the garage. LPA observed in the staff bedroom that there was no smoke detector installed in the bedroom. LPA observed the lock was not working under the kitchen sink which contained a 102 FL oz bottle of Palmolive and 155 oz bottle of Cascade. LPA observed R1's Reappraisal dated 3/18/2022 , R2's Reappraisal dated 1/5/2023, R3's Reappraisal dated 5/20/2022, and R4's Reappraisal dated 5/28/2022. An exit interview was conducted, and a copy of this report, LIC811, and appeal rights were provided to Administrator Uldarico Almiranez.