Routine inspection·November 20, 2025

On 11/20/2025 at 10:45 AM Licensing Program Analyst (LPA) LaVette Farlow arrived unannounced to conduct the required annual visit to the facility. LPA Farlow rang the doorbell and knocked on the door several times, no response. LPA Farlow called the facility phone number and spoke to Maricel Nepomuceno, and explained I was at the facility for the annual inspection. Maricel explained she was not available, and she would see if her Facility Director, Joanna Gomez was available. Maricel called me back and stated Joanna would meet me at the facility in approximately 10 minutes. At 11: 40 AM, Joanna arrived to the facility and LPA Farlow introduced self and stated purpose of the visit. LPA was informed that the facility current census is 0, and the last three residents moved out on Saturday, November 15, 2025 and Sunday, November 16, 2025. LPA Farlow requested the facility to provided the relocation information for the residents and the contact information for their responsible parties. The facility has 4 bedrooms, 2 bathrooms, kitchen, dining area, family room, living room, washer and dry in the garage, attached garage, and backyard. LPA completed a walk through of facility, review of records, and reviewed the MARS. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. LPA observed the facility is currently empty and no residents were present in the facility neither were any personal belonging of the residents remaining in the facility. The facility temperature was 65 degrees Fahrenheit. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected client bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 113.0 and 108.1 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and charged fire extinguisher, the last fire extinguisher inspection was conducted 6/19/2025. Posters such as; the personal rights, CCL complaint poster and disaster plans were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept secured and inaccessible to clients. There was a designated storage space for client/staff files. Since the facility is no longer housing any resident the wasn't any medication present. *** Continued on LIC809C*** LPA observed first aid/CPR kit was complete. All items were, secure and inaccessible to clients. The facility did have emergency kits in the facility for clients in care. There are no firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. Food Service : LPA observed the facility had removed all perishable food items and still had available Non-perishable food supply. Dishes, cups, and utensils were also stored properly. Emergency food and water were also observed. Record Review: LPA reviewed the facility files for three (3) residents files for admission agreements, updated physician reports, and needs and services plans. LPA observed that two (2) out of three (3) residents physician report had expired approximately 30 days ago. A technical violation issued . LPA also reviewed two (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. LPA observed the files were complete and maintained. LPA was unable to conduct a medications audited due to residents no longer residing in the facility. LPA did review the residents MARS and observed Caregiver did not initial the MARS for the three (3) out of three (3) residents prior to their last three (3) days living in the facility. A deficiency cited . Based on the observations made during today’s visit, One deficiency and one (1) technical violation was cited, per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, LIC809D, and appeal rights were discussed and provided to Facility Director, Joanna Gomez.