Routine inspection·September 29, 2025

On September 29, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Assistant Administrator John Jason Eugenio was available to assist with facility inspection. The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for six (6) residents. Currently, there are zero (0) Hospice residents present during today’s visit. This is a single story with attached garage facility. The facility has five bedrooms (two shared resident rooms, two private resident rooms and one staff room) and two full bathrooms. LPA conducted a tour of the physical plant accompanied by Assistant Administrator John James Eugenio, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 115.8 to 121.1 degrees F. A comfortable temperature of 73 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient two day perishable and seven day non-perishable food was maintained. Facility has supply of emergency food and water. Facility has one fire extinguisher which was mounted and fully charged. CONTINUED ON 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The last fire drill was conducted on June 27, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 10/9/2024 – 10/9/2025. A review of six residents (R1-R6) service files and three staff (S1-S3) personnel files revealed to be complete. LPA verified on active certification list, facility has the current administrator's certification on file for John Jason Eugenio #7029054740 - Expiration 10/15/2026. Based on the observations made during today's visit, the following violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided to Facility Representative.