Routine inspection·September 11, 2025

On 9/11/2025, Licensing Program Analyst Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their annual inspection visit. LPA met with staff on duty, Dave Valentine (S1) and stated the purpose of the visit. The designated facility manager, Bulou Matamadua (S2), was notified and arrived later during the visit. Overview : Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents, 4 of which may be non-ambulatory. Facility has a hospice waiver for 3 residents. Bedrooms #1-3 were approved for non-ambulatory use. Bedroom #4 is for ambulatory use only. Initial Observation: Upon arrival LPA was greeted by S1, who informed LPA that there are currently 4 residents present at this time with one staff on duty. One of the residents is currently out. LPA also observed an outside agency staff present but left shortly after. While LPA was setting up for the inspection, LPA observed S1 placed a door knob cover with a combination lock. Per S1, he placed the door knob cover because one resident has a behavior of eloping. Room temperature was at 69 degrees Fahrenheit. Physical Inspection : Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 3 of 4 resident bedrooms and 2 of 2 bathrooms. LPA measured the hot water temperature in the 1 of 2 bathrooms (hallway) to be at 111 degrees Fahrenheit. Both resident bathrooms were observed to be in good repair at this time. LPA inspected the closet in the hallway and observed a cleaner (Fabuluso brand) on the shelf. This closet was unlocked and accessible to residents in care. Fire extinguisher was observed in the living room and was last inspected on 9/4/24. {809-1} Inspection of the garage: LPA observed a bed with pillows on top. Per S1 and S2, the bed was moved from a resident bedroom since the resident received a hospital bed. Further inspection of the garage, in a cupboard, LPA observed a medication container labeled Stool Softener, and it was observed to have pills in it. S2 removed the medication. LPA also observed DME equipment and other furniture/beds. According to S2, these belong to the previous licensees, and S2 still waiting for them to be picked up. Advisory was provided to clean out the garage for resident's safety. Inspection of the outdoor areas: Facility has one exit gate located at the garage side of the facility. Fence and gates were observed to be in good condition at this time. Shaded area and outdoor furniture were observed. Based on today's visit, this annual will require a continuation. The Department will return at a later date to continue the inspection. Deficiencies are being cited. Exit interview was conducted and a copy of this report and appeal rights were provided. {809-2}