Routine inspection·November 4, 2025

Licensing Program Analyst (LPA) Ruth Martinez conducted this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and were greeted and granted entry by caregiver and LPA explained the nature of the visit. There are six residents at the facility and there is one resident receiving hospice services currently. Serparis Dumaliang, Administrator arrived to the facility and met with LPA. LPA began the tour of the inside and outside of the facility. LPA observed resident in the living room watching TV. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in storage a cabinet and refrigerator located in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA observed a small refrigerator with resident medication located in the dining room which contains a lock. LPA observed a first aid kit located with medication. LPA inspected the bathroom and LPA measured the hot water temperature which measured 116.9 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Facility lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants were stored locked in hallway storage Continued on LIC809-C closet. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which had sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher with service date of November 8, 2025, in kitchen. LPA verified fire drills are conducted. LPA began review of records. LPA reviewed four resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed three employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. LPA as a reminder provided annual fee dues information. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.