Routine inspection·December 5, 2025

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by caregiver Benachloe Sabio. LPA discussed the purpose of the visit with caregiver Sabio. According to the facility’s license, there may be a maximum of 6 residents, 4 of whom may be non-ambulatory in approved bedrooms 1 & 5 at any given time at the facility site. The facility is approved for 2 hospice residents. During today’s inspection, the facility’s current census is 5 residents living at the facility. There were no residents present at the facility site during the inspection. LPA inspected the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client 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. There were at least 2 days of perishable food, and at least 7 days of 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 a locked cabinet, which LPA inspected. The facility-maintained medication logs, which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the premises. There is was a fireplace which was not in use and inaccessible to clients. Per caregiver Sabio, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and the facility telephone were all working. A fire extinguisher was present (01) but needed to be serviced within the last 12 months. A first aid kit was complete and readily accessible. LPA spoke with a staff and resident, and reviewed staff and resident records. LPA interviews did not raise any licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were deficiencies observed and cited during today's annual inspection, as well as Technical Violations (TV) and Technical Advisories (TA) issued, which may be found within this report. An exit interview was conducted with caregiver Benachloe Sabio, 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 that the documents were received. LPA requested caregiver Sabio to submit a current Designation of Administrative Responsibility (LIC 308), Personnel Report (LIC 500), and Emergency Disaster Plan (LIC610-E) to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .