Routine inspection·November 24, 2025

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Paul Hernandez, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and six (6) residents present. Administrator William Lee arrived at the facility at 1:00 PM. Facility Overview: The facility is a one-story home with six (6) bedrooms and four (4) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 119°F. Fire extinguisher located at kitchen is a new unit per the purchase receipt. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C...... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Six (6) resident files were reviewed and contained all required documentation. Per physician's reports, Resident #2, 3, 4, and 5 were non-ambulatory. This facility was licensed for 1 non-ambulatory resident. A citation was issued. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for four (4) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 10-27-2025, which met department requirements. All facility exits were clear of obstructions. A citation was issued during the visit. An exit interview was conducted, during which this report was reviewed and provided along with LIC809-D and Appeal Rights.