Routine inspection·July 17, 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 caregiving staff after introducing himself and stating the purpose of the visit. Administrator Eleazar Cuyson was notified via telephone and arrived later to assist with the visit. There are currently six 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 two private bedrooms, two shared bedrooms. 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. Two resident receiving hospice care are observed to have a bed equipped with full-length bed rails. Hospice plans 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 126.2F and 132.2F at two separate faucets used for personal grooming. Type A deficiency cited and civil penalty assessed for repeat violation.. 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 extinguishers present are 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. There are no bodies of water on the premises. Egress alarms are in use on exit doors, however facility does not utilize locked perimeters or delayed egress. LPA reviewed six resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for all six residents with no discrepancies observed. Two residents are found to have been assessed as bedridden per their latest physician reports, however the current fire clearance does not include a provision for bedridden residents. Type A deficiency cited and immediate civil penalty assessed due to the failure to meet the requirements of the fire clearance. LPA reviewed staff records for three staff members present during the visit. CPR training, initial and annual training reviewed for 2024 and 2025. Disaster drills are conducted and documented. Staff members are verified to be background cleared and associated to the licensed location. Based on the observations conducted during the present visit, two type A deficiencies are being cited per Title 22 of the California Code of Regulations. A civil penalty for repeat violation along with an immediate civil penalty were assessed during the visit. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.