Routine inspection·January 12, 2026

On 01/02/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection and Plan of Correction (POC) visit. LPA Lee met with direct care staff Edgar Odongkara and explained the purpose of the visit. LPA Lee requested that care staff Odongkara inform Administrator Violet Mubeezi that CCLD was present at the facility. Approximately 45 minutes later, Administrator Mubeezi arrived and joined the inspection. Upon arrival, LPA Lee observed another individual accompanying Administrator Mubeezi. When questioned, Administrator Mubeezi identified the individual as her sister-in-law (SIL). When LPA Lee asked whether the SIL was a resident, based on LPA Lee’s interaction, the SIL appeared unable to understand the questions being asked. Approximately two hours later, the facility arranged for Uber transportation to return SIL to 1001 Tamarack Ct., Roseville, CA accompany by staff 1 (S1). Administrator Mubeezi stated that both she and her SIL reside at that address. Administrator Mubeezi holds Certificate #7034316740, which expires on 09/09/2027. The facility’s current census is five (5) residents, with two (2) staff members on duty. The facility is a single-story building licensed to serve six (6) ambulatory residents, of whom up to six (6) may be non-ambulatory, with a hospice care waiver granted for four (4) residents. LPA Lee inspected the physical plant, including but not limited to the common areas, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, garage, staff office, and outdoor courtyards, to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be clean, free of odors, and in good repair. Resident bedrooms were properly furnished with appropriate bedding and adequate lighting. CONTINUED LIC 809-C No bodies of water were present on the premises. In the kitchen, LPA Lee observed sufficient seven-day nonperishable and two-day perishable food supplies. Hot water temperature measured 109.6 degrees Fahrenheit at a resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. Smoke detectors and carbon monoxide detectors were observed to be in compliance. The fire extinguisher was located in the dining area and resident hallway and was last serviced in 12/2025. The most recent fire drill was conducted on 12/23/2025. LPA Lee observed a public telephone located in the kitchen and common area and verified that all required postings were displayed. The facility thermostat was observed at 71 degrees Fahrenheit, which is within the required range of 68 to 85 degrees Fahrenheit. Toxic substances were observed stored under the kitchen sink, locked, and inaccessible to residents. Sharp knives were observed locked in a kitchen cabinet and inaccessible to residents. Medications were observed to be locked and inaccessible to residents. The first aid kit was inspected and contained all required components. LPA Lee did not observe any cameras and baby gates in resident bedrooms. LPA Lee also did not observe any residents occupying staff rooms. LPA Lee audited medications for three (3) of five (5) residents by comparing medications on hand with Medication Administration Records (MARs) and determined that the records were not accurate. Resident 1 (R1) had three (3) medications listed on the MAR that were not present in the resident’s medications on hand. Resident 2 (R2) had two (2) medications listed on the MAR that were not present on hand. Per Staff 1 (S1), the medications were expected to be delivered to the facility, refills were not requested by staff, and medications are automatically generated by the pharmacy. Administrator Mubeezi provided LPA Lee with the name of the coordinator responsible for overseeing resident medications and MARs. LPA Lee will follow up with the coordinator. LPA Lee reviewed five (5) of five (5) resident files and found them to be complete. LPA Lee also reviewed two (2) staff files, which were complete. LPA Lee reviewed staff criminal record clearances. Review of records indicated that all facility staff or individuals requiring caregiver background checks must be fingerprint cleared and associated to the facility. Since the SIL was not fingerprinted and associated, Administrator Mubeezi had the SIL leave the facility. LPA Lee informed facility staffs that family members or other individuals who are not fingerprint cleared and associated with the facility are not permitted to be on the premises. CONTINUED LIC 809-C The following documents were provided to LPA Lee during today’s visit: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report Additionally, the purpose of this visit was to also verify the plan of correction that was required to be completed on 12/19/2025 and 12/29/2025 for deficiencies that were previously cited on two prior visits conducted on 12/12/2025 and 12/15/2025. Based upon this inspection, LPAs observed the following: The following deficiencies cited under Title 22 Regulation have been cleared. The license did comply with the terms of the POC-by-POC due date. A POC letter was generated and provided to the licensee: · 87309(a)(1), 87465(a)(6), 87203, 87204(a), 87303(e)(5), 87307(d)(6), 87405(d)(2), 87211(a)(1)(D), 87468.2(a)(1), 87468.1(a)(6), 87468.1(a)(3), 87207, 87464(d) and 87465(a)(4). As a result of this annual inspection and POC visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with care staff Odongkara a copy of these LIC 809 reports was provided to the facility.