Routine inspection·April 17, 2026

Licensing Program Analysts (LPA) Dang Nguyen and Eryn Kane made an unannounced visit to conduct a Required Annual Inspection. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee/Administrator Virgilia “Gigie” Rebosura. 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 six (6) residents in care, of whom one (1) was ambulatory, four (4) were non-ambulatory, and one (1) was bedridden [Resident #1 (R1)]. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] The presence of this bedridden resident represents a violation of the conditions/limitations of the facility license and fire clearance. The facility’s license did not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present. LPAs reviewed care records for all current residents and personnel files for all active staff. LPAs, accompanied by Licensee/Administrator, also toured the interior and exterior of the facility, and inspected all common areas, restrooms, and resident bedrooms. The facility did not have a working carbon monoxide alarm, as required. In the facility’s dining room area were two (2) disinfecting chemical sprays and one (1) container of disinfecting chemical wipes, unsecured/unlocked. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] In the facility’s backyard was one (1) container of disinfecting chemical wipes, one (1) pitchfork with metal points, one (1) full length shovel with metal blade, and one (1) full-length metal pry bar tool, unsecured/unlocked. According to LIC602 Physician’s Reports, five (5) of the six (6) residents in care [R1 through Resident #5 (R5)] had Dementia, and their respective physician had determined that the resident should not have direct access to the above items. Beyond the above, 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. 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. Hot water temperature at taps used by residents for grooming were compliant in temperature: Bathroom #1 Sink was 109.2 F and Bathroom #2 Sink was 109.4 F. Refrigerators and freezers to preserve perishable food were also all 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. Medications were labeled, as required, and stored in locked areas. There were no fireplaces of open-faced heaters accessible to residents. Confidential records were stored in locked areas. No pools or similar bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Smoke alarms, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguishers were serviced within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. There were reserve toiletry supplies, spare linens, and Personal Protective Equipment (PPE) present. Licensee presented proof of current business liability insurance. During review of resident records, LPAs observed, and manager interview confirmed: For four (4) of six (6) residents (R3 through R6), Licensee did not have the name, address, and telephone number of the residents’ dentist to be called in the event of an emergency, as required. R1 and R2 had supplemental oxygen, R2 had a urinary catheter, and R4 had Diabetes (all of which are “Restricted Health Conditions” in the RCFE setting, per regulation). However, Licensee did not have written proof that four (4) of four (4) direct care staff [Staff #1 (S1) through Staff #4 (S4)] had yet received hands-on training from a licensed professional on administration of oxygen, catheter care, and diabetes, which was required before care for these conditions began. [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] R1, R2, and R3 were each receiving hospice care services. However, Licensee did not have written proof that four (4) of four (4) direct care staff (S1 through S4) received “training specific to the current and ongoing needs of the individual resident receiving hospice care” from the resident’s hospice agency personnel (such as the assigned nurse case manager) prior to the start of the hospice care, as was required. Licensee also did not have proof/documentation that they held a care meeting/conference with the responsible person and other appropriate parties for six (6) of six (6) residents (R1 through R6), for the purpose of reviewing and updating the resident’s written record of care / care plan, within the last twelve (12) months, as was required. During review of staff records, LPAs observed, and manager interview confirmed: Licensee did not have proof of current First Aid Training for one (1) of four (4) direct care staff (S2). Licensee did not have written proof that three (3) of four (4) direct care staff (S2, S3, and S4) had completed at least twenty (20) hours of ongoing training within the last year, to include at least eight hours on dementia care and at least four hours on postural supports, restricted health conditions, and hospice care, as required. Licensee did not have written proof that four (4) of four (4) staff who assist residents with medication administration had received at least eight (8) hours of ongoing medication in-service training within the last twelve (12) months, as required. Eight (8) deficiencies were cited per California Code of Regulations, Title 22, and two (2) deficiencies were cited per California Health and Safety Code (refer to the LIC809-D pages). Since one of these deficiencies represents a violation of the facility’s prior-approved fire clearance, an immediate civil penalty of $500 was charged/assessed (refer to the LIC421-IM page). Plans of Correction were jointly developed with the Licensee. LPAs also provided Technical Assistance (TA) regarding knob protectors for safeguarding the facility’s kitchen range and periodic measuring of residents’ body weights (refer to the LIC9102-TA pages). An exit interview was conducted with Licensee/Administrator Virgilia “Gigie” Rebosura, to whom a copy of this report, the LIC 809-D pages, the LIC421-IM page, the LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.