Routine inspection·October 8, 2025

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Licensee Leonor Carmona. According to the facility’s license, the facility has a maximum capacity of six (6) residents, all of whom may be non-ambulatory. LPA, accompanied by Licensee toured the interior and exterior of the facility and inspected each room. The facility was sanitary and in good repair. 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. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas. (Continued on LIC809-C) (Continued from LIC809) No pool or bodies of water are present. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed staff and resident records/files. Per records reviewed and interview with staff two (2) residents in care are receiving hospice care services. The facility does not have an approved hospice waiver on record with the Department. One (1) out of six (6) residents did not contain completed required documents. Confidential records were stored in locked areas. Two (2) deficiencies were cited during todays visit per California Code of Regulations, Title 22 (Refer to LIC809-D). Plan of Corrections for each deficiency were jointly developed with the licensee. An exit interview was conducted with Licensee Leonor Carmona, to whom a copy of this report and Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.