Routine inspection·September 3, 2025

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Jose Jr. Casimiro and was granted entry to the facility. Licensed capacity is (6) current census (4). LPA was accompanied by Administrator Jose Jr. Casimiro 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. 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 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. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated spac for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions. 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 (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (4) resident medications and (2) hospice files. During the medication audit, LPA Rico observed that PRN medications for residents R1 and R2 did not have documentation regarding dosage, administration date, and resident response. Additionally, LPA Rico noted an overflow of resident medications. Staff member S1 stated that the overflow medications had been discontinued; however, the facility did not have a physician’s discontinuation order on file. LPA observed that medications had been transferred from their original packaging into a clear container. LPA Rico also found five loose pills in the medication bins. Furthermore, the facility did not have a copy of its Plan of Operation available for review. Facility phone was out of service.LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Based on the observations made during today’s visit, five deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809)(LIC809D) (APPEAL RIGHTS) was discussed and provided to Administrator Jose Jr. Casimiro