Routine inspection·November 5, 2025

Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Beena Singh met with a staff, was granted entry to the facility. At the time of the visit there were two (2) staff present, and four (4) residents present. Licensee/Administrator Heldo Taguba was contacted and arrived during the visit. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room and detached garage/stock room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which (6) can be non-ambulatory residents and one (1) may be bedridden resident. The facility has six (6) Hospice Waiver. The current census is four(4) residents. LPA Beena Singh was accompanied by Licensee/Administrator Taguba (S1) 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). LPA Beena Singh observed no obstructions to outdoor passageways. The facility is maintained at a comfortable temperature LPA Beena Singh 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 Beena Singh observed grab bars and customized tiles that functions as non-skid mat or strips in the resident bathrooms. Moreover, during the tour of the facility, LPA Beena Singh observed the knives drawer was locked in the kitchen and not accessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the kitchen. Also, LPA Beena Singh observed a complete first aid kit maintained and readily available at the facility. LPA Beena Singh measured and observed the water temperatures in the bathroom to be at 110 degrees F. 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, Infection Control Plan were posted in a common area. Food Service: Seven (7) days of non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. LPA Beena Singh observed sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Beena Singh reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. The files were complete with updated physician’s reports, admissions agreements, and pre-admissions appraisals. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications/MAR records were audited and appeared to be dispensed appropriately by staff members. Liability Insurance valid through 12/12/2024-12/12/2025. Fire/disaster/Earthquake drill was conducted on 10/03/2025. An exit interview was conducted where this report was discussed and provided to Licensee/Administrator Heldo Taguba.