Routine inspection·August 15, 2025

On 8/15/2025 at 09:40 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA Serrano met with Administrator Manzoor Massey and was granted entry to the facility. At the time of the visit there was two (2) staff present, and six (6) residents present. The facility is a five (5) bedrooms, 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 six (6) non-ambulatory and two (2) hospice waiver and 1 maybe bedridden resident and the current census is six (6) residents. LPA was accompanied by Staff #1 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 73 degrees Fahrenheit. LPA Serrano 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. LPA measured and observed the water temperatures in the bathroom to be at 120 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms.. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** LPA observed that the garage side door handle is broken. Deficiency issued. 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 cabinet with the resident’s medications locked. LPA observed complete first aid kit and first aid book at the facility. Food Service: More than 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 does not have 72 hour emergency food for the resident although the facility have plenty of emergency water in the premises. Deficiency 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. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and need and services plan. LPA observed resident files were missing the needs and services plan for resident #1(R1) and resident#2(R2). Deficiency issued. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings.LPA observed that staff#2 (S2) does not have the health screening report. Deficiency issued. Based on the observations made during today’s visit, Deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, LIC9102 and LIC809D and appeal rights were discussed and provided to Administrator Manzoor Massey.