Routine inspection·April 20, 2026

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Rose Ann Ang and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 10:30AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 6-bedroom, 2-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA and AD observed 2 staff and 5 residents present at the facility. Resident Bedrooms: the 5 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the one staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 134 and 142 degrees F in the 2 resident bathrooms, before corrections. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the outdoor storage closet. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are not yet past due. At about 8:30AM, LPA reviewed 5 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 5 residents. Facility does not handle resident money. LPA provided California Department of Public Health informational material on Legionnaires’ Disease during the inspection. During the inspection, LPA and AD observed the following: based on documents, R1, R2, R3, R4, and R5 are non-ambulatory, the facility has a fire clearance for two non-ambulatory and was unable to provide documentation showing their fire clearance request received January 8, 2025 for six non-ambulatory was approved; based on observation, the water temperature in the two resident bathrooms tested at 134 and 142 degrees F; based on observation, the licensee did not ensure staff medications were inaccessible to residents in the non-lockable staff bedroom and none of the residents are assessed as being able to safely be around unlocked medications; and based on documents, the physician's reports for R1, R2, R3, R4, and R5 are on the old form and do not contain required information, including behavioral expressions. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.