Routine inspection·July 17, 2025

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to conduct the annual required visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. Facility is licensed for 3 ambulatory and 1 non-ambulatory clients with a hospice waiver for 4. The facility currently has 4 clients with none on hospice. Divina Alipio has an Administrator Certificate expiring on 06/19/2026. Administrator David Alipio arrived during the visit. The facility appears clean, safe and sanitary. LPA Lyman along with Caregiver Soccorro Sarmiento toured the facility at 11:48 AM. LPA toured the physical plant, checked food service, and reviewed facility documentation. The home consists of four client bedrooms, two shared hall restrooms, living room, dining room, and kitchen. Client bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Client restrooms were checked. Toilets and water faucets worked properly, and shower was free of mold/mildew. Water temperature measured between 109.4 and 110.6 degrees F in facility restrooms. Client bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguisher is fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for clients. Exit gates are unlocked, self latching and operational. LPA observed ample emergency food and water supply as well as emergency packs for clients. LPA reviewed the emergency disaster plan as well as infection control plan during the visit. Plans are thorough and complete. Facility conducts quarterly emergency drills with the last one conducted on 07/02/2025. Facility provides activities in the form of games, exercise and outings in the community. At 12:30 PM, LPA reviewed four client files and three staff files. CONTINUED ON LIC 809C DATED 07/17/2025 Client files contained required documents including admission agreements, physician reports and client appraisals. Staff files contained required documents such as criminal background clearance and health screening. Two out of three staff are missing required training hours. LPA reviewed medication storage and administration. Facility uses a medication administration record. Medications are stored in a locked cabinet and are being administered per physician order. LPA reviewed P & I money with staff. Ledgers match cash on hand. Based on the observations made from today's visit, deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the Administrator and a copy was provided to Administrator as well as Appeal Rights.