Routine inspection·September 11, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Bonifacio Mercado and explained the reason for the visit. Administrator (Admin) Rowena Carillo arrived approximately 12pm. LPA observed two caregivers on duty providing care to six residents of which three are under hospice care. The Administrator's Certificate for Rowena Carillo expires on June 24, 2027 and June 3, 2027 for Administrator Angeline Delos Reyes. The following was observed during the inspection: This is a single story structure located in a residential neighborhood. Facility operates within the conditions and limitations specified on the license. There are six private resident bedrooms and four resident bathrooms. All common areas were inspected including the attached two car garage. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 109.5,107.7, 105.0, and 107.4 degrees Fahrenheit in the resident bathrooms. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway is free of obstruction. The shed stores mattresses which is inaccessible to the residents. The two exit gates were operational and there were sufficient seating and shading. The fire extinguisher was purchased on today's date per review of the receipt. The auditory devices in two residents' rooms, Resident #1 (R1) and Resident #6 (R6) were not operational. The dual functioning smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency food/water in the garage. Emergency evacuation drills are being conducted quarterly with the last date on July 15, 2025. LPA observed the required 'See Something, Say Something' (PUB475) poster posted in the entry way. LPA conducted interviews and audited six residents' files and two personnel files in which no discrepancies were found with the exception of a missing Physician's Report (LIC602) for R1. Medications were audited for two out of six residents. No discrepancies found. The following was advised: to ensure the facility is in good repair at all times, to repair or replace the auditory devices on the sliding doors of bedrooms R1 and R6, to ensure all documents are readily available for the licensing agency to review and to avoid any future delays, and to ensure the Physician's Report (LIC602) is complete and maintained. Based on the observations made during today's visit, a deficiency is being cited and Advisory Notes are being issued. An exit interview was conducted with Administrator Rowena Carillo, and a copy of this report including the LIC811, LIC9102s, and the appeal rights were provided at the end of the visit.