Routine inspection·May 7, 2026

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 Gloria Anyiam, Caregiver. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Five (5) 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-1 has no association, 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 maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current 09/17/2027. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 111.0 degrees F. (Continued on LIC809, Page 2) (Continued from LIC809, Page 1) Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in an area in the garage; the machines have been relocated from the designated laundry room. 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 Food Service- Food supply meets one week supply of nonperishable and 2-day supply of perishables food on hand. Food prep areas are clean and organized. LPA made observations 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 has been changed according to the approved floor plan-the designated laundry room has been converted into a caregiver room, garage was observed setup with mattress, personal furniture and belongings to Administrator. 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 05/7/2026. The facility is not conducting emergency disaster drills every quarter, documentation observed for 4/2/2026 and 10/3/2025. Based on the information received during this visit today, there are three (3) deficiencies and Civil Penalties issued for $200 is being cited per Title 22, Division 6 of The California Code of Regulations. This report, 809D, Appeals Rights, LIC421BG and Civil penalties was reviewed with Alan Nakamure and a copy provided at the time of the exit interview.