Routine inspection·October 26, 2025

Licensing Program Analyst (LPA) LaVette Farlow made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA was greeted and granted entry by staff Yoseva Ernawati. Yoseva contacted the Administrator of my arrival. LPA later met with Administrator Eric Schwarcz. At the time of the visit there was two (2) staff present, and six (6) residents present. The facility is a five (5) bedroom, three (3), bathroom home, with a kitchen/dining area, living room, staff living area, and attached garage. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (6) current census (6). LPA was accompanied by Facility Administrator, 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 (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be 109.3, 106.8, and 104.3 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. 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. Medications are kept inside cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Facility Files: LPA view the facility folder for Infection Control Plan, Emergency Disaster Plan, Fire/Earthquake drills, Resident Roster LIC 9020, and Personnel Roster LIC500. LPA conducted a random audit of residents medication. Upon review of two (2) out of two (2) residents MARS had discrepancies. LPA found that the MARs was initialed prior to medication being dispensed and medication was not listed on the MARS that was PRN medication and medication that needs to be destroyed still in the resident container. A deficiency issued. Based on the observations made during today’s visit, two deficiencies were 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 was discussed and provided to Facility Administrator Eric Schwarcz.