Routine inspection·December 11, 2025

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility's history was reviewed prior to the visit. LPA identified herself and was granted entry by caregiver Arian Ysais. LPA discussed the purpose of the visit with caregiver Ysais and licensee Charise Dela Cruz who later arrived and joined the visit. According to the facility’s license, there may be a maximum of 5 residents, all of whom may be non-ambulatory in bedrooms # 1 - 4 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 3 residents living at the facility. There were 2 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. Toxic chemicals and poisons were inaccessible to residents. Medications were properly labeled, as required, and stored in locked area, which LPA inspected. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the premises. The facility fireplace was inaccessible to the residents. Per licensee Dela Cruz, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and the facility telephone were all working. Fire extinguishers were present (01) and serviced within the last 12 months. The first aid kit was complete and readily accessible. LPA spoke with staff, and reviewed staff and resident records. LPAs visit 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 was a deficiency observed and cited during today's annual inspection that may be reviewed on the LIC809-D page of this report along with Technical Advisories. An exit interview was conducted with licensee Charise Dela Cruz, 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 was provided an updated Emergency Disaster Plan (LIC610-E), Designation of Administrative Responsibility (LIC 308), and insurance updates during the visit. LPA requested licensee Dela Cruz to submit a current Personnel Report (LIC 500), to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .