Routine inspection·December 4, 2025

On December 4, 2025, at 10:30 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 was greeted and granted entry by staff. LPA Kim met with Administrator (AD) Maria Pricilla Mirabueno and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents 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: four (4) resident bedrooms, caregiver bedroom, two (2) 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 Caregiver Marvin Moso. There were no bodies of water 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, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 107.0 degrees F to 108.5 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 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 is stored in the kitchen and in the garage, and emergency water and emergency supplies were stored in the garage. The facility has one (1) fire extinguisher that was charged, mounted in the kitchen, and inspected on September 19, 2025. 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 (714-332-0130) and videoconferencing internet accessible device both remain available. First Aid kit had all the necessary elements. Certificate of Liability Insurance was effective from June 23, 2025, and will expire June 23, 2026. LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S3), and medication and medication administration record that were all in order and complete. LPA Kim conducted interviews with two (2) staff and four (4) residents. No deficiencies were cited during today’s inspection visit. An exit interview was conducted, and a copy of this report was provided to Administrator Maria Pricilla Mirabueno.