Routine inspection·September 8, 2025

On 9/8/2025 at 11:45 AM, Licensing Program Analysts (LPAs) Eldin Serrano and Magda Malcore made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPAs met with Administrator Marcelina Bandao and was granted entry to the facility. At the time of the visit there was two (2) staff present, and five (5) residents present. The facility is a three (3) bedrooms, two (2) 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 six (6) non-ambulatory and six (6) hospice care waiver and 1 maybe bedridden and the current census is five (5) residents. LPA was 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 79 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom to be at 105 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 first aid book at the facility. 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. LPAs observed that the facility does not have the 72 hour emergency food but they have sufficient water. Citation issued. 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 have 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 certification, criminal record clearance, trainings, and health screenings. LPA found that staff#3 (S3) does not have criminal background clearance on file. Deficiency will be issued. Based on the observations made during today’s visit, two (2) deficiences were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809D forms, and Appeal Rights were discussed and provided to Administrator Marcelina Bandao.