Routine inspection·December 9, 2025

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Jenny Pham and discussed the purpose of the visit. The facility is a single story home with two caregiver rooms, three resident bedrooms, one tenant bedroom, staff office, five bathrooms, living room, kitchen, dining room, and attached two car garage. LPA observed the resident bedrooms and observed that they had the required components and furnishings. LPA observed the bathroom off the main hallway to have rodent droppings in one of the empty drawers. LPA tested the water to be between 105.8 and 115.8 degrees Fahrenheit in the facility restrooms. LPA observed the restrooms to have toilet paper and textured flooring in the showers. LPA observed the kitchen to have rodent droppings and traps set. LPA observed the knives to be in a locked drawer at the end of the counter. LPA observed the appliances to be operational. LPA observed a two day perishable and seven day nonperishable food supply on hand. LPA observed the toxins and chemicals to be locked and made inaccessible to residents in the closet by the front door. LPA observed the staff office to be locked and made inaccessible to residents. LPA observed the centrally stored medication to be locked in the staff office and made inaccessible to residents in care. LPA observed a clean supply of linens in the hall cupboard for resident use. LPA observed the front and back yard to have a shaded seating area for resident use. LPA observed no debris and obstructions on the facility grounds. LPA observed a tenant renting a room in room 4. The tenant is background cleared and associated to the facility. Continue on LIC809-C LPA reviewed staff files and no discrepancies were observed. LPA reviewed resident files and 3 of 3 residents do not have a completed needs and services plan and 1 of 3 residents do not have a medical assessment with a tb test on file. LPA observed resident medications and 2 of 3 residents had a lapse in medication due to facility staff not refilling their prescriptions before they had run out causing the medication to not be given as prescribed. LPA observed the emergency disaster plan has not been filled out in its entirety. LPA did not observe an emergency disaster drill. All staff are background cleared and associated to the facility. LPA informed AD that the annual fees are due and provided the PIN number at the time of the inspection. Based on today’s observations technical violations and deficiencies are being noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD and a copy of this report along with technical violations, LIC809C, LIC 809D, LIC 858, LIC859 and appeal rights were left at the facility.