Routine inspection·September 12, 2025

On September 12, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Adriel Pao was notified via telephone and later arrived to assist with the inspection LPA observed that Adriel Pao has a valid Administrator certificate which expires on July 19, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a single story home with five resident bedrooms, one staff bedroom, three bathrooms, two of which are for residents, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portions of the facility. On today's visit, LPA observed five resident in care and three care giving staff present. LPA observed residents eating breakfast in the dining room. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all five resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the two resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 129 and 130.2 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed a fire extinguisher to be mounted on the wall in the kitchen and it was observed to be charged and serviced as of July 17, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on September 3, 2025. LPA observed the centrally stored medication to be kept in a locked cabinet located in the kitchen. LPA observed the facility has a First Aid Kit stored in the kitchen and it has all the required components. LPA inspected the laundry room and observed it to be free of hazards. LPA observed chemicals and toxins to be stored in a locked cabinets in the laundry room. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gate of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all five resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPA observed the facility was providing over the counter medications without a prescription to Resident #1 (R1), Resident #2 (R2), Resident #4 (R4), and Resident #5 (R5). LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D. An exit interview was conducted with Administrator Adriel Pao. A copy of the report and Appeal Rights were provided.