Routine inspection·September 22, 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 administrator Troy Ujimori after stating the purpose of the visit. There are currently three residents in care, one of which is receiving hospice care at this time. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas. LPA accompanied by facility staff toured the physical plant. The facility is a two-story house with four private bedrooms (one of which is vacant) and one shared room which is also vacant. There are two shared bathrooms used by residents, one of which is en-suite from the shared bedroom. Licensee stated their intent to host visiting family members in the shared bedroom and was provided with a consultation regarding the requirement to obtain a clearance and association to the facility ahead of time. All occupied bedrooms appear clean and sanitary. One resident uses half-length rails for postural support, but no physician orders are on file. Type B deficiency issued. 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 109F in one of the bathrooms used for personal grooming. 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 FORM LIC809 There are two wall-mounted fire extinguishers present, both verified to be charged with up-to-date maintenance tags. Carbon monoxide and smoke detectors were found to be present and operational. Emergency water supplies are observed to be stored in the garage. LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with outdoor furniture for resident use. The identified routes 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. The facility does not utilize locked perimeters or delayed egress. LPA reviewed three resident records which included most necessary components. Physician report established upon admission for resident R1 is not on file. A consultation was also provided on the updated requirements regarding medical assessments. LPA reviewed resident medication records and prescription orders with no discrepancies observed. LPA reviewed staff records for two staff members during the visit. Proof of current CPR training reviewed. Disaster drills are conducted once yearly and not documented. Type B deficiency issued. All staff members are verified to be background cleared and associated to the licensed location. The administrator certificate is listed as pending on the Department's website. 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 were provided to a facility representative.