Routine inspection·July 23, 2025

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to caregivers Kashian "Eric" Apilan and Alma Meza. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. The facility is approved for four (4) hospice waivers. During today’s inspection there were six (6) residents in care, with five (5) present at the facility. Administrator Diep Malmberg arrived at the end of LPA's visit. LPA and Caregiver Apilan 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. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink was 105F and kitchen sink read at 108.1F. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. LPA observed knives to be in an unlocked drawer and accessible to residents in care. Staff interviews revealed that the drawer is kept unlocked while staff are working in the area then locked afterwards. Staff interviewed revealed that residents are unable to ambulate without assistance, but as LPA could not access files during their visit to confirm, a citation was issued per Title 22 regulations regarding the unlocked knives. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients.  Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per caregiver Apilan, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, as well as emergency lighting were present and all in working order. Fire extinguishers were noted to have been purchased over one (1) year ago and were not serviced within that time. A deficiency is being cited per Title 22 regulations and noted on the attached LIC 809D. In addition, a Civil Penalty is being assessed for a Zero Tolerance Violation regarding Fire Safety and are noted on the attached LIC 421IM in the amount of $500. First aid kit was incomplete, missing a first aid manual and thermometer, for which a Technical Violation was issued. Required licensing postings were observed in visible areas of the facility, however there was no posting of the required "Let us Know" poster, for which another Technical Violation was issued. LPA interviewed two (2) staff and one (1) client, and interviews did reveal concerns of staff being unable to access resident files. LPA was unable to review facility records as they were locked and inaccessible to facility staff present and the Administrator unable to arrive to present them. A deficiency was cited for failure of staff to have access to necessary records and inability to present records to licensing staff. While conducting the physical tour of the building, LPA noted that the copy of proof of liability insurance for the facility was expired and staff were unable to present LPA with a copy of valid and current coverage. A deficiency was cited per Title 22 regulations. Four deficiencies were cited during the inspection. An exit interview was conducted with Administrator Malmberg to whom a copy of this report, the LIC 421IM, two LIC 9102 forms (Technical Violations), and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.