Routine inspection·December 8, 2025

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 (S1) . During today’s visit, LPA met with Kian Pascual, Administrator Designee (AD). The facility is a five bedroom , two bathroom single-story home with an approved fire clearance of six non-ambulatory residents of which one may be bedridden . Five residents are approved for hospice. The facility currently has a census of five residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits . The hot water temperature measured between 109.4 and 112.1 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational . The fire extinguisher is charged and was serviced on December 3, 2024 and an appointment for service is scheduled on December 9th from 12-3pm. The facility’s last fire drill was conducted on September 9, 2025. This quarter's fire drill will take place by the end of this week. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. Water and emergency supplies were located in the front closet and garage. A weekly menu was posted on the refrigerator door. All stove burners and appliances were operational. The sharps and knives drawer had a lock that needed repair but facility brought in a person to fix the lock prior to LPA's exit. LPA confirmed lock is in working order. (Continued on LIC 809-C) (Continued from LIC 809) LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit had all of the required elements with a First Aid Manual. LPA observed four of five residents watching the news in the living room, LPA interviewed alert residents for quality care being provided. LPA toured resident rooms and observed all the rooms had the required furnishings and linens. Postural supports were provided for one resident with bed rail orders on file. AD addressed that other residents would benefit from bed rails and will follow up with Primary Care Physician for residents. Upon touring the exterior LPA observed two self-latching exterior gates with an alarm system. The garage is detached and is only used for car and supplies storage. There were no hazards or obstacles in outdoor pathways and a shaded seating area and cycle machine were observed for resident use. LPA reviewed two of two staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on May 25, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Kian Pascual, Administrator Designee and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.