Routine inspection·June 3, 2025

Licensing Program Analysts (LPAs) Mary Rico and Antoinette Davis made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with House Manager Rosemarie Macadangdang and was granted entry to the facility. Licensed capacity is (6) current census (5). LPA was accompanied by House Manager Rosemarie Macadangdang 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, nightstands, 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 residents in care. There was a designated space for resident /staff files. 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 (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (5) resident medications and (2) hospice files. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. During medication audit, LPA Rico observed 1 out of the 5 resident's medications was documented as given, but based records the medication bottle was missing and S1 stated the medication was discontinue. Based on the observations made during today’s visit, (1) one deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809D) was discussed and provided to House Manager Rosemarie Macadangdang. Along with a copy of appeal rights.