Routine inspection·October 22, 2025

Licensing Program Analyst (LPA) Hanna Gough arrived at the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Caregiver August Rebollar and discussed the purpose of the visit. Caregiver informed LPA that the Administrator is currently flying back to California and will not be able to come to the facility for the visit. The facility currently has six residents in care. The facility is a one story home with six resident bedrooms, one staff bedroom, six bathrooms, kitchen, two living rooms, attached garage and backyard. Facility appears clean, safe and sanitary. LPA observed the resident bedrooms to have the required components and furnishings. LPA observed a fresh supply of clean linens in the closet by the front door. LPA observed the resident restrooms to have toilet paper, paper towels and textured shower flooring. LPA tested the water to be between 123.2-124.0 degrees Fahrenheit. LPA observed Caregiver turn the water heater down during the inspection. LPA observed the kitchen to be clean and free of vermin. LPA observed a two day perishable and seven day non perishable food supply on hand. LPA observed the toxins to be locked under the kitchen sink. LPA observed the knives to be locked in a drawer next to the kitchen sink. LPA observed the centrally stored medication to be in a locked cabinet located in the dining room. LPA observed the garage to store an extra food supply and toxins and chemicals on separate shelves. LPA observed the garage to be locked and made inaccessible to residents in care. LPA observed the backyard to be free of debris and obstructions. LPA observed an accessory dwelling unit (ADU) that is being used as a staff bedroom that was not observed on the fire clearance. A civil penalty was assessed at the time of the inspection. LPA observed a shaded seating area in the backyard for resident use. LPA and Caregiver tested the carbon monoxide and smoke detectors and they were found to be operational. Continue on 809-C LPA reviewed staff files and 2 of 2 staff files were incomplete. LPA observed resident files and 3 of 6 residents did not have a medical assessment for review and 5 of 6 residents did not have an updated needs and services plan. LPA did not review an updated disaster plan. LPA reviewed resident medications and 2 of 6 residents have medications without prescriptions. All staff are background cleared and associated to the facility. Based on today’s observations a civil penalty and citations are being assessed per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report, LIC 809D, 858, 859, technical violation, civil penalty, and appeal rights were left at the facility.