Routine inspection·August 14, 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 Supervisor Jamily “Jamila” Hallak. LPA then met with Licensee/Administrator Maria Williams, 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, and one (1) may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of five (5) residents, of whom four (4) were non-ambulatory and one (1) was bedridden. LPA interviewed multiple staff and multiple clients. LPA also reviewed the care records for all clients, and the personnel files for multiple active staff. LPA also toured the interior and exterior of the facility and inspected all common areas and bedrooms. The facility 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 shower 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 73 F. Where tested, hot water temperature at taps accessible to clients were compliant in temperature: Bathroom #1 Sink was 109.2 F and Bathroom #2 Sink was 109.4 F. Appliances to preserve perishable food were also compliant in temperature. Cooking/dining equipment and utensils were present and in good condition. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] There was no fireplace or swimming pool (or similar bodies of water) on the premises. There were no sharp/hazardous objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Centrally stored medications and confidential records were kept in locked areas. Per the Licensee, no firearms or ammunition are kept at the facility. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present. Carbon monoxide detectors, smoke alarms, night lights, and emergency lighting were working. The facility’s fire extinguisher was serviced within the last twelve (12) months. A complete First Aid kit was present. Required licensing postings were observed in visible areas of the facility. There were reserve supplies of Personal Protective Equipment (PPE). Licensee presented proof of current business liability insurance. During review of resident records, LPA observed, and manager interview confirmed: For 4 of 5 residents [Resident #1 (R1) through Resident #4 (R4)], Licensee did not within the last twelve (12) months arrange a care conference meeting, to include the resident, their responsible person, their home health or hospice agency personnel (where applicable), and facility staff, as required. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] During review of training records, LPA observed, and manager interview confirmed: Licensee did not ensure that 16 of 16 staff [Staff #1 (S1) through Staff #16 (S16)] were trained on Personal Protective Equipment (PPE) within the last year, as required. Licensee did not ensure that 16 of 16 staff (S1 through S16) were trained on the facility’s written Emergency and Disaster Plan within the last year, as required. While Licensee did perform two (2) fire drills within the last calendar year, these fell short of the emergency/disaster drill frequency and variety required by regulation. Two (2) deficiencies were 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 tracking of residents’ body weights (refer to the LIC9102-TV page). An exit interview was conducted with Licensee/Administrator Maria Williams, to whom a copy of this report, the LIC 809-D pages, the LIC9102-TV page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today's visit.