Routine inspection·August 19, 2025

On August 19, 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) Sherly Tongol was notified via telephone but could not arrive to assist with the inspection. LPA observed that Sherly Tongol has a valid Administrator certificate which expires on December 19, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for six. The facility is a single story home with six private resident bedrooms, one staff bedroom, two shared resident bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA, accompanied by a care giving staff, conducted a tour of the interior portions of the facility. On today's visit, LPA observed six resident in care and two care giving staff present. LPA observed residents watching TV in the living room. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all six 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 shared 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 113 and 115.7 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. CONTINUED ON LIC809-C 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. LPA observed the five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a separate locked kitchen cabinet under the sink. LPA observed fire extinguishers to be mounted on the wall by the entryway of the facility, in the living room, in the kitchen, and in the unattached two car garage. LPA observed fire extinguishers to be charged and serviced as of October 8, 2024. LPA tested the individual smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on May 24, 2025. LPA observed the centrally stored medication to be kept in a locked cabinet by the staff bedroom. LPA observed the facility has a First Aid Kit stored in the locked cabinet and it had all the required components. LPA, accompanied by a care giving staff, 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. LPA inspected the unattached two car garage. 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. There are no bodies of water on the premises. LPA reviewed all six resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPA reviewed three staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with an authorized facility representative and a copy of the report was provided.