Routine inspection·September 23, 2025

On 9/23/25, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a required - 1 Year inspection visit. LPA met with Diana Miclos (S3) and explained the purpose of the visit. An entrance interview was conducted. Facility administrator Ramona Del Roy (S2) moments later. Administrator certification for S2 expires on 2/2026. The facility is licensed to serve up to 6 ambulatory residents. Current census is 6. LPA toured the facility with S1. Age range 60 and over. 6 bedridden. Hospice waiver for 4. LPA toured the physical plant with S3, including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 111.2*F which was within the required range of 105-120*F. The temperature inside the facility measured at 73 degrees *F, which is within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. the last emergency drill was conducted 7/23/2025.LPA observed "oxygen in use signs" to be posted in visible areas. LPA observed two residents playing Dominos with staff onthe dining table. Exterior passageways were clean and clear of any obstructions. Continued on 809-C There is a covered patio area with table and chairs client and visitor use, furniture observed to be in good condition. Clients are supervised at all times when they are outside. There is a gates with a self-latching mechanism for persons to exit the backyard in emergencies. LPA observed a locked shed which contains general equipment and supplies. LPA requested resident and staff files for review. LPA reviewed (3) staff files and (6) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following forms and documents were obtained: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited. An exit interview was conducted, and a copy of this report was provided to facility.