Routine inspection·April 8, 2026

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 Leota Guevara. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of whom one (1) may be bedridden in Bedrooms 1, 2, or 6. Hospice waiver for four. During today’s inspection there were four (4) residents in care. LPA with Staff Guevara 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. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client 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 residents. Medications were labeled, as required, and stored in locked areas. The swimming pool on the premises was fenced, locked, and inaccessible to residents. Per Staff Guevara, 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. Review of facility records revealed that Administrator Michelle Matamoros’s administrator certificate expired on 08/02/2025. LPA reviewed the Department’s Administrator Certification Bureau (ACB) website and verified Administrator Michelle Matamoros was not listed on the active certificate list nor on the pending renewals application list. Review of resident records revealed that Resident #1 (R1) and Resident #2 (R2) did not have the results of their communicable tuberculosis test in their files. Furthermore, review of resident records revealed that R1 and R2 did not have a reappraisal on file, and Resident #3 (R3) and Resident #4 (R4) had their last reappraisals in 2024. Confidential records were stored in locked areas. Three (3) deficiencies were cited per California Code of Regulation, Title 22. A plan of correction was jointly formulated, and an exit interview was conducted with Staff Guevara whom a copy of this report, LIC809-C, LIC809-D pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.