Routine inspection·October 3, 2025

On October 3, 2025, at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Olimpia Lang, after stating the purpose of the visit. Administrator (AD) Sheryl Tongol arrived at the facility at short time later and was present throughout the inspection. The facility is licensed to operate for six (6) non-ambulatory residents, of which one (1) may be bedridden, and has a hospice waiver for four (4) residents. The building is a single story structure located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) staff bedroom, four (4) bathrooms, living room area, dining area, kitchen, an outdoor covered seating areas, and an attached two car garage. During the inspection, LPA obtained copies facility records including: Resident/Staff Roster, LIC 500 (Personnel Record), Staff Schedules for September and October 2025, and proof of Liability Insurance. Based on record review and interviews, S1 and S2 was not associated prior to working at the facility which poses an immediate Health, Safety, or Personal Rights risk to persons in care. Civil Penalties Assessed. LPA Bentley toured inside and outside of the physical plant with AD Tongol. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked and available at the time of visit. Bathrooms were found to be clean and operational. The water temperatures in four (4) bathrooms measured between 122.5 – 132.9 degrees F. A deficiency is being cited. Continues on LIC 809-C A comfortable temperature of 76 degrees F was maintained in the facility. LPA Bentley observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency safety drills were last conducted on July 11, 2025, and conducted quarterly. First aid kit is maintained and contains all the necessary elements. During the visit, the smoke detectors and carbon monoxide detectors were tested and operable. A working telephone (714-594-3568) remains available, and the facility has a device that can be used for video teleconference purposes. Emergency food, emergency water, and emergency supplies were stored in the garage. The facility has two (2) fire extinguishers that were charged, mounted, and last serviced on July 11, 2025. Liability Insurance is effective November 18, 2024, and expires on November 18, 2025. LPA Bentley conducted an audit of six (6) resident files (R1-R6), five (5) staff files (S1-S5), and medication and medication administration review were conducted. A review of six medication administration records revealed inconsistencies, and a deficiency is being cited. During the visit, LPA Bentley conducted resident interviews and staff interviews regarding care provided. Based on observations, deficiencies and civil penalties are being cited during this visit as per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report, LIC809-D, LIC811s, LIC421BG, and appeal rights were provided to Administrator Sheryl Tongol at the end of the visit.