Routine inspection·November 4, 2025

On November 04, 2025, at 9:00 AM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Nazarina Vega and explained the purpose of today's visit. The facility Administrator holds current certificate and expires on August 07, 2025. The facility is licensed for six non-ambulatory clients. There are currently four residents who reside at this facility. The facility has an approved hospice waiver for five. Zero out of the five hospice placements are occupied. The LPA Martinez toured the facility with Rona Geronimo, 2025, at 2:00 PM. LPA Martinez reviewed four resident files; six staff files; and two medication files. Facility staff files were complete. Four out of four resident files were missing reappraisals. Resident 1's (R1) medication order, medication bottle label, and Medication Administration Record (MAR) have different dispense instructions for Famotidine 40 MG. Medication order states, "take 1 tablet by mouth daily at bed time." The MAR states, "take 1 tablet daily." The medication bottle label states, "take 1 tablet by mouth 2 times a day." R1's Ferosul 325 MG bottle label states, "take 1 tablet by mouth every other day or as directed." However, the bottle was altered to state, "everyday" with a black marker. The facility is not following R3's melatonin 10 MG medication order. R3' MAR indicates that care staff have been administering one 10 MG tablet daily. However, the Melatonin tablet being administered daily is 5 MG. In addition, the MAR does not indicate that two 5 MG tablets are being administered daily. Continued.. R3's MAR states, "Buspirone 10 MG- 1.5 tablet 3 times daily." The Buspirone medication bottle label states, "15 MG- take 1 tablet by mouth 3 times a day." The medication order states, "15- MG take 1 tablet by mouth 3 times a day." R3's MAR states, "Calcium Citrate 1 tablet daily." The Calcium Citrate bottle has a label, and the dosage is 700 MG. The Calcium Citrate medication order states, "250 MG- take 1 tablet by mouth daily. Facility fire extinguisher was last inspected on July 25, 2025. The facility smoke and carbon detectors were in good repair. The exterior emergency exit gate was in good repair. The facility has a first aid kit. The facility has a locked closet for medication storage. Resident bedrooms, common areas, kitchen, bathrooms, and laundry room were furnished and sanitary. The facility has a public telephone located at the kitchen. The facility has an adequate food supply. The facility water temperature measured at 105 degrees and the facility temperature measured at 72 degrees. The exterior of the home is clear of debris, and the resident patio is furnished and in good repair. The facility shed is used as storage room. The facility does not have interior or exterior cameras. The facility sketch is current. Bedroom one is occupied by one resident Bedroom two not occupied. Bedroom 3 is occupied by one resident. Bedroom 4 is a staff room. Bedroom 5 is occupied by two residents. LPA Martinez will continue to follow up facility resident bedroom layout and fire clearance request. As a result of this annual inspection visit, the following deficiencies were cited, per California Code of Regulations, Title 22 and Health and Safety Code: 87465(e)(2) Incidental Medical and Dental Care; 87465(a)(6) Incidental Medical and Dental Care; 87465(h)(4) Incidental Medical and Dental Care; 87465(a)(4) Incidental Medical and Dental Care; and 87463(a) Reappraisals. An exit interview was conducted, and a copy of the 809 report, 809D-Page, and appeals right were given to the facility at the end of this visit.