Routine inspection·November 6, 2025

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Staff Michelle Velazquez. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of whom two (2) may be bedridden. Hospice waiver for four (4). During today’s inspection there were five (5) residents in care. LPA with Staff Velazquez toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. LPA observed Bedroom #1 as a shared resident bedroom with a bathroom. LPA observed no door between the toilet and shower area and the shared bedroom to maintain individual privacy. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Staff Velazquez, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC809-C] LPA reviewed facility records. Confidential records were stored in locked areas. Interviews revealed that Staff #1 (S1) began employment with the facility more than five (5) days ago and LPA observed S1 present during today’s visit. Review of CCLD’s Guardian and Licensing Information System (LIS) databases showed that S1 had not completed the required criminal background clearance process prior to working. Two deficiencies were cited per California Code of Regulation, Title 22 (refer to the attached LIC 809-D pages). Since one of the deficiencies was related to an employee working at the facility without a background clearance, a Civil Penalty of $500 was also assessed (see the LIC421-BG page). A plan of correction was jointly formulated, and an exit interview was conducted with Staff Velazquez to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.