Routine inspection·December 5, 2025

On 12/5//2025 at 9:15 AM, Licensing Program Analysts (LPAs) Eldin Serrano, Magda Malcore and Andrew Martinez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with house manager Stephanie Smith and was granted entry to the facility. At the time of the visit there was one (1) staff, and five (5) residents present. The facility is a four (4) bedroom, three (3) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of 6 and which five (5) non-ambulatory and six (6) hospice care waiver and 1 maybe bedridden and the current census is five (5) residents. LPAs were accompanied by a staff to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPAs inspected resident bedrooms; they are equipped with the required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom to be at 110 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine closet with the resident’s medications locked. LPAs observed first aid kit and manual. Yards/Outside : One shaded patio, two (2) side gates with self-latching handles on both side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstructions. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. LPA observed that the facility has the 72 hour emergency food and water. Care & Supervision: The facility has an Administrator present in the facility with enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Also, LPAs observed that the facility has dementia residents. Record Review: LPAs reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPAs observed resident files reviewed were complete. LPAs reviewed three (3) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. LPAs observed that staff #1,#2 (S1,S2) do not have health screening reports available for review. Deficiency issued. LPAs observed that staff #3 (S3) do not have the required CPR/First aid training. Deficiency issued. Based on the observations made during today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC909C, LIC809D forms, and Appeal Rights were discussed and provided to House Manager Stephanie Smith.