Routine inspection·September 2, 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 Caregiver Nancydita “Nancy” Gala. LPA then met with Administrator Eva Paras, who arrived shortly after. 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 three (3) residents in care, and all were non-ambulatory status. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter doors, and neither 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 all residents in care, and multiple staff. LPA reviewed care records for all residents, and personnel records for all active staff. During the facility tour, LPA observed, and manager interview confirmed: The facility’s dedicated telephone line was non-working. [During today's visit, Licensee contacted their phone service provider to make an 09/04/2025 appointment to remedy this.] The facility’s fire extinguisher had not been professionally serviced/inspected since 2022. (This was required to be done annually.) Where tested, hot water temperature at taps used by residents were initially too cold: Bathroom #1 Sink was 98.6 F, Bathroom #2 Sink was 98.6 F, and Bathroom #3 Sink was 98.2 F. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] (Regulation required hot water temperature at these taps to be between 105 F and 120 F). [During today’s inspection, adjustments were made to the facility’s water heater settings, which brought these taps back into the complaint temperature range.] Beyond the above, the facility’s physical plant 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 75 F. 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. Required licensing postings were observed in visible areas of the facility. Carbon monoxide detector, smoke detectors, night lights, and emergency lighting were working. No fireplaces or pools/bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Licensee presented proof of current business liability insurance. During a review of resident records, LPA observed, and manager interview confirmed: For 3 of 3 residents [Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3)], Licensee did not within the last twelve (12) months arrange a care conference meeting to review the respective resident’s plan of care, as required. (Regulation requires such meetings to include the resident themselves, their responsible person, their home health or hospice agency personnel where applicable, and facility staff.) [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 812-C, 1 of 2] During a review of training and administrative records, LPA observed, and manger interview confirmed: Licensee did not ensure that 6 of 6 staff [Staff #1 (S1) through Staff #6 (S6)] had been trained on Personal Protective Equipment (PPE) within the last year, as required. Licensee did not maintain a written LIC610E Emergency Disaster Plan (or equivalent document) which satisfies the requirements of HSC 1569.695. Licensee also did not perform quarterly disaster drills, as required. Four (4) deficiencies was 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). Plans of Correction were jointly developed with the Licensee. LPA issued one (1) Technical Violation (TV) regarding a videoconferencing device dedicated for resident use (refer to the LIC9102-TV page). LPA also issued Technical Assistance (TA) regarding refresher training for staff on California Mandated Reporting requirements (refer to the LIC9102-TA page). An exit interview was conducted with Administrator Eva Paras, to whom a copy of this report, the LIC 809-D pages, the LIC9102-TV page, the LIC9102-TA page, the LIC811 Confidential Names List pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.