Routine inspection·April 1, 2026

On April 1, 2026, at 2:00 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Licensee Kelly Ho arrived at the facility and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) bathrooms, living area, den kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with Caregiver Gener Gutierrez. There were no bodies of water or obstructions in the facility. 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 at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were clean. The water temperature measured at 106.7 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. The top right drawer next to the refrigerator was broken. When the drawer was opened, the bottom of the drawer was not connected to it. Emergency food, emergency water, and emergency supplies are stored in the garage. The smoke detectors were operable. LPA observed carbon monoxide detector was not operating as intended. The detector would go off without any carbon monoxide issues. A working telephone (714-463-4194) remains available. Last emergency drill was conducted on March 25, 2026. First aid kit is maintained and contains all the necessary elements. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S7), and medication and medication administration record. LPA Observed appraisal needs and service plan for R1 dated 1/26/2024, R2 dated 3/12/2024, and R3 dated 1/10/2024. LPA Kim conducted one (1) staff interviews and four (4) resident interviews. LPA interviewed S2 who stated that S1 pre-made medication containers for each resident and time from March 28, 2026, to April 1, 2026. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed carbon monoxide detector not operating as intended and the top shelf in the kitchen drawer next to the refrigerator was broken. LPA interviewed S2 who stated that S1 pre-made medication containers for each resident and time frame from March 28, 2026, to April 1, 2026. LPA observed and took photos of the containers the facility used. LPA observed appraisal needs and service plan dated for R1 dated 1/26/2024, R2 dated 3/12/2024, and R3 dated 1/10/2024. An exit interview was conducted, and a copy of this report, LIC811, LIC809D, and appeal rights were provided to Licensee Kelly Ho.