Routine inspection·September 23, 2025

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Angie Lim. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Administrator arrived shortly. Resident record review began- Two (2) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Employee records review began- Three (3) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to meet the needs of the clients in care. Administrator certification is present, current until 08/05/2026. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is not maintained at a comfortable temperature for the clients-AC is not functioning at level. Lighting is sufficient for safety and comfort. Water temperature measured 111.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. (Continued from LIC809, Page 1) (Continued from LIC809, Page 1) Food Service- Food supply meets the of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are not clean and organized. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 06/30/2025. The facility conducting emergency disaster drills quarterly; last done on 7/2/2025 Corporation is active and in good standing. Based on the information received during this visit today, there are one (1) deficiency that are being cited per Title 22, Division 6 of The California Code of Regulations. This report, LIC809D, LIC809G and Appeals Rights was reviewed with Chermaineanne Laudato and copies provided at the time of the exit interview. LPA has requested updates to the following documents to be submitted to the CCL by 09/29/2025: LIC 200 to change capacity with revised floor plan.