Routine inspection·July 7, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility administrator/caregiver Eleazar Cuyson after stating the purpose of the visit. There are currently four residents in care, three of which are receiving hospice care at this time. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas. LPA accompanied by facility staff toured the physical plant. The facility is a two-story house with an attached garage, with four private bedrooms, one shared bedroom. There are are one shared and one en-suite bathrooms on the premises. The upstairs portion of the house is strictly for staff use and verified not to house any residents during the visit. Bedrooms appear clean and sanitary. One resident receiving hospice care is observed to have a bed equipped with full-length bed rails. Hospice plan of care reviewed. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 111.9F. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. The fire extinguisher present is charged with up-to-date maintenance tag. Carbon monoxide and smoke detectors were found to be present and operational. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 The garage is secured and used for the storage of supplies and food as well as the laundry area. Emergency food and water supplies verified to be present. All utilities (gas, water, electricity, internet and cable) are verified to be operational during the visit. Fresh groceries are also present. LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with furniture for resident use. The identified routes of egress are free of clutter and obstructions. There are self-latching gates on both sides of the premises. The swimming pool present in the backyard has been emptied due to lack of maintenance in the context of an ongoing dispute with the facility's landlord. It is adequately fenced and treated to avoid pests. Egress alarms are in use on exit doors, however facility does not utilize locked perimeters or delayed egress. LPA reviewed four resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for two out of four residents with no discrepancies observed. LPA reviewed staff records for two staff members present during the visit. CPR training, initial and annual training reviewed for 2024 and 2025. Disaster drills are conducted and documented, however the most recent quarterly drill was not conducted as scheduled due to one staff member undergoing medical treatment. Consultation provided. Staff members are verified to be background cleared and associated to the licensed location. Based on the observation conducted during the present visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative.