Routine inspection·February 3, 2025

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 2/3/25 at 9:30am. Administrator certificate expires 4/23/26 for Alexander Salvador . License fees are current. LPA met with Merly Aguda and stated the purpose of todays visit. The facility is licensed for a capacity of 12 residents of which 4 maybe non-ambulatory. There are 0 non-ambulatory residents at this time. Residents approved for rooms 6 & 7. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. There are 9 bedrooms of which 7 are for residents and 3 bathrooms. The temperature inside the facility was observed to be at 70*F which is within the required range of 68-85*F. The most recent emergency drill was conducted on 11/9/24. The hot water temperature was measured at 119.5*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed 1 residents and 1 staff files during this visit. LPA did observed 2-day perishables and 7-day non-perishables. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-NA Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-(if applicable)Submit Infection Control Plan-(if applicable)Submit Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.