Routine inspection·January 21, 2026

On 01/21/2026, Licensing Program Analysts (LPAs) Beena Singh and Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs met with staff/care giver Titus Irangus and was granted entry to the facility. At the time of the visit there were one (1) staff present, and three (3) residents present. LPA Singh explained the purpose of the visit to staff/care giver Titus Irangus. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry area and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has two (2) Hospice Waiver. The current census is four (4) residents. LPA was accompanied by staff/care giver Titus Irangus 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). LPA observed no obstructions to indoor passageways. The facility is maintained at a comfortable temperature of 76 degrees Fahrenheit. LPAs inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps and chairs and sufficient lighting in the bedrooms. During the walk through, LPAs observed kitchen cabinet to be in despair. In addition, LPAs also observed no working lights in the laundry room. While inspecting facility garage LPAs observed a leakage coming from the water filter LPAs observed mold on the wall due to the leakage. LPAs will issue deficiency. Moreover, LPAs observed that bathrooms were clean, and appliances were operating appropriately. LPAs observed grab bars and non-skid mat in the resident bathrooms. ***Continuation in LIC809C *** LPAs observed night-lights maintained in hallways and passages to non private bathrooms. LPsA observed the outdoor passageways free of obstructions. LPAs observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperature in the bathroom to be at 110 degrees Fahrenheit. The facility is equipped and working with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication cabinet. Food Service : Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision : LPAs observed one staff sufficient number of staff to provide care and supervision to the residents in care. LPAs observed Emergency supplies in one of the cabinets. LPA observed first aid kit and first aid manual at the facility. Record Review : LPAs reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPAs reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with tuberculosis (TB) test results. LPAs observed on-the-job training provided and documented Residential Care for the Elderly (RCFE) and Dementia, Postural Supports, Hospice Care training. LPAs observed no issues. LPAs audited Medication administration Record system (MARS) matched with medication administrated to the residents. LPAs observed there were activity program for the residents at the facility.Fire drill conducted on 12/1/2025.Liability Insurance valid through 03/28/2025 to 03/28/2026.License fee is current 1/21/2026. Deficiencies were cited during today's visit. An exit interview was conducted where this report, LIC809, LIC809C, 809D and Appeal Rights were discussed and provided via email to Licensee-Sandy Zhao due to technical issues during this visit..