Routine inspection·January 28, 2026

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for six non-ambulatory residents. Facility has an approved hospice waiver for six residents and the home currently has three residents. Administrator (AD) Restituto Calilung arrived shortly to conduct facility tour. AD provided updated liability insurance that expires on 4/3/2026. LPA along with AD toured the facility at 1:05 PM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of six resident bedrooms, living room, dining room, kitchen, three bathrooms and an attached garage along with an ADU for staff. The facility recently when through a remodel to add 2 bedrooms. Licensee is in process of applying for a new fire clearance to accommodate the 2 bedrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. At 1:10PM, LPA observed bleach under the sink in the bathroom across bedroom 1 unsecured and accessible to residents. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 116.3 degrees F and 117.5 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 10/5/2025. Continued on LIC809-C dated 1/28/26 Outside grounds were toured. Walkways around the home were clear of hazards. Exit gates is unlocked and operational. LPA observed the emergency food and water supply. First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed three resident files and one staff file. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff file reviewed did not contain evidence of 20 hour of required annual training nor current first aid certification. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Medications are being administered per physician order. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the licensee and a copy was provided along with appeal rights.