Routine inspection·December 16, 2025

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six residents. As of today, the facility has six residents admitted to the facility. All six residents were present during the inspection. There’s a total of 5 bedrooms, of which 4 bedrooms are for the residents, and one bedroom is for staff. There are two restrooms available. There’s a living room space, a dining space, backyard, and an attached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Grab bars are tightly secured to the wall. No chemicals observed in the bathroom. Hot water measured in the range of 108.6 – 109.5 degrees F. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. Sharps are kept locked drawer near the sink. Cleaning solutions are stored in a locked cabinet directly below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. Resident & Staff Files : Resident and staff files stored in a locked cabinet area behind the dining table. File Review: 3 of 6 resident files were reviewed during the visit, and three staff files were reviewed. No discrepancies were noted. Medications/First-Aid Kit: Resident medications are stored in a locked medication cabinet in the dining area. A first aid kit with a manual was observed in the garage. Continued on LIC809C Medication Review: 3 of 6 resident medications were reviewed during the visit. No discrepancies were noted. Medications are being administered as prescribed. Linens & Hygiene Supplies: Hygiene items and a supply of linens was observed in closet. Garage/Storage Room: The garage is clean and organized. The garage is used to store miscellaneous facility items. There is a laundry area with a washer and dryer. There’s a supply of incontinent care items. Disaster items and emergency water was observed in the garage. Backyard/Exterior: The backyard is clean and well organized. Walkways are free of obstruction. A table and chairs was observed under a shaded patio area. Bodies of Water: None Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: A fire extinguisher was observed in the kitchen. An emergency evacuation drill: Was conducted October 24, 2025. Evacuation drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted and available for review on the main postings board behind the dining table. Additional Comments: Licensing fees are current and facility contact information was reviewed and the proper facility number was provided: 714.527.5082. The facility profile will be updated. No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.