Routine inspection·October 31, 2025

Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct an annual inspection. LPA met with facility administrator care staff, Maureen Graant S1 and explained the purpose of the visit. S1 called the facility administrator and stated they were unable to come to the facility and S1 can assist with the annual inspection. An entrance interview was conducted with S1. The facility is licensed for a total of six (6) non-ambulatory residents ages 60 and over; Hospice waiver for two (2) granted. The current census is five residents, one staff. LPA observed one staff in the dining room singing along to YouTube videos on their tablet, two resident watching television in the living room and all other residents int their rooms. LPA observed residents were each given a Halloween treat bag by care staff. LPA and S1 inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of five residents. The facility temperature was 74 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 119 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. LPA observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA observed a locked cabinet for the storage of medication. LPA observed locked cabinets for the storage of cleaning solutions and knives. The shelf liners in cabinets are warped and in need of repair or replacement. Continued on 809-C LPA requested resident and staff files for review. LPA reviewed three (3) staff files and five (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. The current administrator, Romeo Apuya is not listed as having a current administrator certificate not only listed on the on current LIC 500 schedule as on-call, an updated administrator certificate or administrator shall be provided by Licensee. Administrator should be at the facility a sufficient number of hours to properly manage the facility. There is a current administrator certificate for Geronima (Emma) Bautista. Two out of five residents are in need of an updated annual physicians visit in November 2025 and are scheduled already. Licensee shall have enough staff to ensure care for five residents including meeting care needs and providing activities for residents. The following forms were requested to be submitted by 11/07/2025 to Cynthia.tamayo@dss.ca.gov: • LIC 500 Personnel Record LIC 308 Designation of Administrative Responsibility • LIC 309 Designation of Administrative Responsibility • Updated LIC 500 Personnel Report • LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance • LIC 9020 Register of facility clients/residents • Copy of Administrator Certificate(s) • Update Administrator with CCLD, if Romeo Apuya is no longer the administrator Per the California Code of Regulations, Title 22, Division 6, Chapter 8 no deficiencies were cited during this visit. Technical assistance was provided as described above. An exit interview was conducted and a copy of this report was left with staff member Maureen Grant.