Routine inspection·August 6, 2025

On 8/6/2025, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a Required - 1 Year visit. LPA met with administrator, Glenda Molinyawe and explained the purpose of the visit. Administrator Lianna Sisayan is out on vacation. Current LIC 308 designated S1 as Designated Facility Responsible person. This facility is licensed to serve six (6) non-ambulatory residents. Non ambulatory of which one may be bedridden in bedroom #1. Hospice waiver approved for two. The current census is 6. There is currently one resident on hospice. LPA toured the facility with S1, LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient 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 observed to be within the required range of 105-120*F. The temperature inside the facility measured at 72*F which was 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. Smoke and carbon monoxide detector(s) in the facility were in good repair. continued on 809-C LPA observed security cameras in the hallways and common areas, there were no security cameras in private areas such as resident bedrooms or bathrooms. Licensee is in the process of requesting bedroom #1 change into a bedridden room. LPA observed an activities calendar posted in the dining room bulletin board. At around 2:50 PM, Resident Frances G was transported by Alpha 1 during this visit due to pain/ Nephrostomy tube not draining properly. S1 stated they will submit an Incident report to CCLD. LPA requested resident and staff files for review. LPA reviewed (3) staff files and (5) 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. LPA discussed LIC 624 and reporting requirements with S1. The following forms and documents were requested to be submitted within 15 days: Copy of Administrator Certificate, LIC 500 (August), LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance, LIC 308 Designation of Administrative Responsibility (current). Per the California Code of Regulations, Title 22, no deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to facility.