Routine inspection·April 23, 2026

On April 23, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPA Initially met with staff on duty, Richard Baltazar (S1) and stated the purpose of the visit. The administrator, Lit Tien (AD) was notified and unable to be present today. Facility supervisor, Jose Ernesto Pasion (S2), arrived shortly after and assisted with the inspection. Overview : Facility is a one-story building located in a residential neighborhood. Facility is licensed to serve up to 4 elderly residents, 2 of which may be non-ambulatory. Facility does manage residents’ cash resources. Facility does not have clearance for bedridden, delayed egress, and/or locked interior/exterior. Physical Inspection : Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 4 of 4 resident bedrooms and 2 of 2 bathrooms. In Bedroom #1 of the facility sketch, the exit door to the outside did not have proper ramp, as the height of the ramp is more than half an inch down. Advisory given to obtain appropriate ramp. Room temperature was maintained at 68 degrees F. The hot water temperature was measured at 117 degrees Fahrenheit. Smoke and carbon monoxide detectors were observed throughout. In the kitchen, the facility maintained at least a seven-day supply of non-perishable foods and a two-day supply of perishable foods. However, LPA observed only 3 kinds of fruits (banana, strawberries, oranges). LPA did not observe fresh vegetables in the refrigerator. Per interview with S1 and S2, they serve canned vegetables as preferred by residents in care. S2 confirmed there is no documentation that indicates their residents’ food preferences. Per review of the menu, vegetables are included. One fire extinguisher was observed in the kitchen area. Sharp objects were in a locked drawer. Cleaning solutions and dish soaps were in a locked cabinet under the sink. {1 of 2} Laundry room was inspected. Laundry soaps and hygiene supplies were observed to be locked in cabinet. The garage area was not locked. Inside the garage, LPA observed a laundry detergent in one of the cabinets that can be accessed by residents in care. The garage also has a refrigerator; inside this refrigerator, LPA observed 2 bottles of Pepto Bismol and are accessible to residents in care. Outdoor area was inspected. LPA observed covered areas with outdoor furniture. Ramps, fence, and exit gate were observed to be in good repair at this time. At the kitchen/dining exit door, going to the patio at the back, LPA observed the ramp to be missing. For shut off valves, initially, S2 was unable to locate the location of the electric and gas shut off valves until he called the AD. Per S2, he does not know how to operate the gas shut-off valves. Record Reviews: Review of 4 of 4 resident files was conducted, including but not limited to, review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. PRN Authorization Letter was on file for each resident. Medication reviews were conducted for 2 residents. For residents that require injection treatment, they did not have Restricted Health Care Plan in place prior to retaining those residents. Cash (P&I) records were reviewed for 3 residents. Staff counted 3 residents’ money in front of LPA. Review of 4 staff files included but not limited to background clearance, first aid/CPR certification, and training. Emergency Procedures Plan and Infection Control Plan were reviewed. Facility conducts monthly disaster/fire drills. Reminders were provided to review their plans at least annually. Staff tested one of the smoke/carbon monoxide detectors and were found to be operable. Documents Requested: LPA requested a copy of updated Liability Insurance Certificate, Surety Bond, LIC500, and LIC308. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were cited and advisories were provided. An immediate Civil Penalty was assessed today in the amount of $500 due to fire clearance violation by removing the ramp at the exit door in the kitchen/dining area. Plan of corrections were discussed during exit interview was with Jose Ernesto Pasion. A copy of the report and appeal rights were provided upon exit. {2 of 2}