Routine inspection·August 11, 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’s Vida Villacorta and Cristita Romero. LPA discussed the purpose of the visit with caregiver’s Villacorta and Romero, and licensee Jesusa Pascua who later arrived and joined the visit. According to the facility’s license, there may be a maximum of four (4) residents two (2) of whom may be non-ambulatory in at any given time at the facility site. During today’s inspection, the facility’s current census is 3 residents living at the facility. There was one resident present at the facility site upon LPA’s arrival to the facility and two residents who returned from their respective day programs during the inspection. LPA, accompanied by caregiver Romero and later with Licensee Pascua, toured 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. Resident’s bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present and stored. 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 76 degrees Fahrenheit (F). Hot water temperature at taps accessible to resident were also compliant: kitchen sink measured hot water at 112.5 degrees F; sink in restroom #1 delivered hot water at 114.8 degrees F; and sink in restroom #2 delivered hot water at 114.1 degrees F. [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. The facility kept additional food storage. Cooking, dining equipment and utensils were present, and all safely cleaned and stored. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked cabinet. The facility-maintained medication logs which LPA reviewed. No pools or bodies of water on the premises. Per licensee Pascua, 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 were complete and readily accessible. LPA spoke with a resident and staff and reviewed staff and resident records. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked cabinet. Required licensing postings were observed in a visible area of the facility. The Licensee was made aware of the updates needed to their Plan of Operations to include Department updated from January 1, 2025. There were no deficiencies observed or cited during today's annual inspection. An exit interview was conducted with Licensee Pascua 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 Licensee Pascua to submit their current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, and Emergency Disaster Plan LIC 610-E to the licensing office within 10-business days. A copy of their updated Liability Insurance was provided to LPA during the inspection. Forms are available at www.ccld.ca.gov .