Routine inspection·July 14, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Maria Lat was notified of the visit via telephone and arrived later to assist. There are currently three residents in care, none of which are receiving hospice care at this time. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas and conducted interviews with the residents. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage, with six private bedrooms, one of which is assigned to caregiving staff. There are two en-suite bathrooms used by residents and a locked bathroom used only by staff. Bedrooms appear clean and sanitary. No residents are observed to be using postural supports at the time of the visit. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 119F in one of the bathrooms and at 122F in the other bathroom. Consultation provided and water temperature adjusted. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 Both mounted fire extinguishers present are verified to be charged. Carbon monoxide and smoke detectors were found to be present and operational. The garage is secured and used for the storage of supplies and food as swell as laundry. Emergency water supplies are observed. LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with furniture for resident use. The identified route of egress is free of clutter and obstructions. There are self-latching gates on both sides of the premises. There are no bodies of water present. Egress alarms are in use on exit doors, however facility does not utilize locked perimeters or delayed egress. LPA reviewed three resident records which included all necessary components. No bedridden residents are present. LPA reviewed resident medication records and prescription orders for all residents. Centrally stored medication lists need to be updated as some information is no longer valid. Consultation provided. Facility staff is stated to be preparing medication doses for the entire week ahead of time. Type B citation issued. LPA reviewed staff records for two staff members present during the visit. The only valid CPR training present is for administrator Maria Lat, therefore no trained staff is present on the premises overnight. Type B citation issued. No documentation for the initial and annual training for both staff members is present. Type B deficiency cited. The last disaster drill conducted and documented is dated September 8, 2024. Type B citation issued. Staff members are verified to be background cleared and associated to the licensed location. The administrator certificate is pending and has been submitted to the Department at this time. Consultation provided. Based on the observation conducted during the present visit, four type B deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided.