Routine inspection·October 29, 2025

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Caregiver Maria Pacleb. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, ages 60 and over. The facility has an approved hospice waiver for three (3), and bedridden waiver for one (1). During today’s inspection there were five (5) residents in care. LPA and Caregiver Maria Pacleb 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. 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 client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. 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 Maria Pacleb, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. (Continued on Page 2, LIC809-C) (Continued from Page 1, LIC809) LPA interviewed staff and clients, and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. One (1) deficiency was cited per California Code of Regulations, Title 22, and one (1) deficiency was cited per California Health and Safety Code (refer to the LIC809-D page). Plans of Correction were jointly developed with the Caregiver Maria Placeb. LPA also provided instruction on a Technical Violation (TV) regarding first aid supplies (refer to the LIC9102-TV page). An exit interview was conducted with Caregiver Maria Pacleb to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.