Routine inspection·September 17, 2025

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Staff Ricardo Rojas Garcia and was granted entry to the facility. Licensed capacity is (6) current census (3). LPA was accompanied by Staff Ricardo Rojas Garcia to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. Hot water temperature tested at 74 degrees Fahrenheit. Deficiency will be issued. A previous licensing report was issued on 10/18/2024 giving notice of the same violation. Because you have been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. An immediate civil penalty of $250 is hereby assessed for the date of 09/17/2025. There was a designated office for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA was unable to enter room that is locked. Deficiency will be issued. A previous licensing report was issued on 10/18/2024 giving notice of the same violation. Because you have been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. An immediate civil penalty of $250 is hereby assessed for the date of 09/17/2025. There was a designated office for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. LPA Hernandez observed common room upstairs with bed. Deficiency will be issued. Additionally, LPA observed no activity calendar for residents in care. Deficiency will be issued. A previous licensing report was issued on 10/18/2024 giving notice of the same violation. Because you have been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. An immediate civil penalty of $250 is hereby assessed for the date of 09/17/2025. There was a designated office for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed for Resident #1 (R1) and Resident #2 (R2) no updated physician report. Deficiency will be issued. A previous licensing report was issued on 10/18/2024 giving notice of the same violation. Because you have been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. An immediate civil penalty of $250 is hereby assessed for the date of 09/17/2025. Additionally, LPA observed no pre-placement appraisal for R1. Deficiency will be issued. A previous licensing report was issued on 10/18/2024 giving notice of the same violation. Because you have been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. An immediate civil penalty of $250 is hereby assessed for the date of 09/17/2025. LPA observed no reappraisal made for R1. Deficiency will be issued. LPA observed no needs and services plan for R1. Deficiency will be issued. LPA reviewed (3) residents medications. LPA observed incorrect documentation of PRN medications for Resident #3 (R3). R3's medication is labeled as PRN but being given as a daily medication. Deficiency will be issued. Furthermore, LPA observed no updated centrally stored medication log for R3. Deficiency will be issued. Additionally, LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. LPA observed no required staff training for Staff #1 (S1) in file. Deficiency will be issued. LPA observed no plan of operation for facility. Deficiency will be issued. A previous licensing report was issued on 10/18/2024 giving notice of the same violation. Because you have been cited for repeating the same violation within 12 months, the following civil penalty shall be assessed until the violation is corrected. An immediate civil penalty of $250 is hereby assessed for the date of 09/17/2025. Additionally, LPA observed no fire/earthquake drills being done. Last drill was dated May 2025. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies and civil penalties were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) and (LIC809D) (LIC421FC) was discussed and provided to Staff Ricardo Rojas Garcia