Routine inspection·October 29, 2025

Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct an annual inspection. LPA met with facility administrator Christine Torres (S1) and Teresa Autencio (S2) and explained the purpose of the visit. The facility is licensed for age range 60 and over with clearance for 3 ambulatory and 3 non-ambulatory residents. The administrator certificate for S1 is current (#7012851740) and will expire 10/23/2026. The current census was six residents and three staff LPA toured the physical plant was conducted with S1 to ensure residents’ health and safety and the facility is in compliance with Title 22 regulations. The following was observed: LPA toured the facility with Torres and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas with S2. Furniture and furnishings were sufficient to meet the needs of six residents in care. The facility temperature was 75 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 113 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. LPA observed three light fixtures needed light bulb replacement in two resident bedrooms, licensee stated they will replace all bulbs once they are need of replacement. LPA observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA observed a locked cabinet for the storage of medication. LPA observed medications requiring refrigeration are stored in a locked lock box stored on top shelf of the refrigerator. LPA observed locking cabinets for the storage of cleaning solutions and knives. Outdoor activity areas that are easily accessible to residents, protected from traffic, and have adequate shady areas. Continued on 809-C LPA reviewed five resident files (R1-R5) and two staff files (S1-S2). LPA provided Licensee with LIC 311, licensee will ensure all required records are in resident/staff files are signed and dated. The following documents were collected by LPA Tamayo and will be added to the facility file: (1) LIC 610 Current Emergency Disaster Plan (2) Proof of Current Liability Insurance (3) LIC 500 Current Personnel Report (4) Administrator Certificate The following documents were requested to be submitted to LPA Tamayo by 11/4/25 at 5:00PM to cynthia.tamayo@dss.ca.gov: (1) LIC 309 Administrator Organization (2) LIC 308 Designation of Administrative Responsibility As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with S1, and a copy of these LIC 809 reports were provided to the facility.