Routine inspection·July 14, 2025

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee/Administrator Lilia Rena. According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of four (4) residents in care, of whom one (1) was ambulatory and three (3) were non-ambulatory, but none were bedridden. The facility’s license does not include endorsements for delayed-egress doors or secured perimeters, and none of these were present. LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility and inspected all common areas and resident bedrooms. LPA interviewed multiple residents and multiple staff. LPA reviewed care records for all residents and personnel records for all active staff. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 74 F. Where tested, hot water temperature at taps accessible to residents were all compliant: Kitchen Sink was 113 F, Bathroom #1 Sink was 112.5 F, and Bathroom #2 Sink was 114.1 F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] Appliances to preserve perishable food were also compliant in temperature. 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. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. No fireplaces or pools/bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detector, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher had been professionally inspected within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. Fire/disaster drills were performed at required intervals. There were reserve supplies of Personal Protective Equipment (PPE) and staff were trained on PPE within the last twelve (12) months. Licensee presented proof of current business liability insurance. During facility tour, LPA observed, and manager interview confirmed: The facility’s manual fire alarm pull station and bell alarm had not been inspected/serviced within the last twelve (12) months. Two (2) of six (6) smoke detectors were initally non-working. [During today's visit, Licensee inserted fresh batteries into both smoke detectors, correcting the problem.] These items were necessary to maintain ongoing compliance with the facility’s prior approved Fire Clearance. During records review, LPA observed, and manager interview confirmed: Licensee did not record the name, address, and telephone number of a primary dentist for 4 of 4 clients [Client #1 (C1) through Client #4 (C4)], as required. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the LIC809-D page). Plans of Correction were jointly developed with the Licensee. LPA also issued one (1) Technical Violation (TV) regarding a videoconferencing device dedicated for resident use (refer to the LIC9102-TV page), and Technical Assistance (TA) regarding staff alert devices on exit doors and refresher training on Mandated Reporting requirements for staff (refer to the LIC9102-TA pages). An exit interview was conducted with Licensee/Administrator Lilia Rena, to whom a copy of this report, the LIC 809-D page, the LIC9102-TV page, the LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.