Routine inspection·October 30, 2024

Licensing Program Analysts (LPAs) Juliana Barfield, David Roman, and Licensing Program Manager (LPM Lizzette Tellez, conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs and LPM were welcomed by, identified themselves to, and discussed the purpose of the visit with, Caregiver Alfredo Pacleb. According to the facility’s license, the facility has a maximum capacity of six (6) residents, all of whom may be non-ambulatory. During today’s inspection, there were a total of six (6) residents in care, and per medical records, all were non-ambulatory. This facility does not feature a secured perimeter or delayed egress doors. LPAs accompanied by Alfredo Pacleb, toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. 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. Hot water temperature in resident bathroom was compliant. There were at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters observed. No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. 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. Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Amsal Engdaw, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.