Routine inspection·July 21, 2025

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by caregiver Teofila Mayo. LPA discussed the purpose of the visit with Administrator Vanessa Sanchez. Licensee Angelita Sanchez later arrived and joined the visit. According to the facility’s license, there may be a maximum of five (5) residents, four (4) of whom may be non-ambulatory in rooms 1, 2, and 4 in at any given time at the facility site. The facility is approved for a wheelchair in room #4 and 1 hospice is approved. During today’s inspection, the facility’s current census is two (2) residents living at the facility. There were 2 residents present at the facility site during the inspection. LPA, accompanied by caregiver Erminda Aquino, toured the interior and exterior of the facility, and inspected each room. The facility was clean and in good repair. There was an insect found during the inspection. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 73 degrees F. Hot water temperature at taps accessible to residents read as follows: kitchen sink initially measured hot water at 135 degrees F but later measured 111 degrees F; sink in restroom #1 delivered hot water at 120 degrees F; sink in restroom #2 initially delivered hot water at 136 degrees F, but later measured at 113.5 degrees F; and sink in restroom #3 initially measured hot water at 137.7 degrees F, but later measured at 111.6 degrees F. The hot water temperatures were lowered during the inspection and were cleared. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking, dining equipment and utensils were present, and all safely stored. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked areas which LPA inspected. The facility-maintained medication logs which LPA reviewed. No pools or bodies of water on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was present (01) and serviced within the last 12 months. First aid kit was complete and readily accessible. LPA interviewed staff and residents, and reviewed staff and resident records. LPA interviews did not raise any licensing concerns. The resident files which LPA reviewed contained required documents. Staff files were not complete but were stored in a locked area. Required licensing postings were observed in a visible area of the facility. On July 7, 2022, the facility was cited on section, 87211(a)(1)(D) Reporting Requirements, Any incident which threatens the welfare, safety or health of any resident . The facility had ongoing construction which threatened the welfare of the residents, that was not reported to the Department. This citation is being cleared during this annual inspection. Title Section, 87305 (a) Alterations to Existing Buildings or new facility is being cited and is cleared during todays inspection. It may be reviewed on the LIC809-D page of this report. On April 15, 2024, the facility was cited on sections 87458(a) Medical Assessment, which is being cleared during today’s inspection. All medical assessments for residents in care are current and on file. The facility was also cited for 87465 (a)(5)(A) Incidental Medical and Dental Care, Medications usually prescribed for self-administration which have been authorized by the person's physician . This section is being cleared during this inspection. Although Incidental Medical and Dental Care are cleared, the facility is pending staff medication training and is being cited during today’s inspection which may be reviewed on the LIC809-D page of this report. [CONTINUED FROM LIC 809-C] [CONTINUED FROM LIC 809-C] There are additional deficiencies observed and being cited during today's annual inspection which can be reviewed on the LIC809-D page(s) of this report. An exit interview was conducted with Administrator Vanessa Sanchez and Licensee Angelita Sanchez to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received. LPA requested Administrator Sanchez to submit a current Personnel Report LIC 500, and Emergency Disaster Plan LIC 610-E, to the licensing office within 10 business days. A current Designation of Administrative Responsibility LIC 308 was provided to LPA during the visit. Forms are available at www.ccld.ca.gov .