Routine inspection·April 13, 2026

Licensing Program Analyst (LPA) Dang Nguyen made 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 Leticia Manuel. LPA then met with Licensee/Administrator Penelope Pankey, who arrived shortly after. LPA performed a welfare check on residents in care and interviewed facility staff. LPA reviewed the care records for all residents in care, and the personnel files of all active staff. LPA, accompanied by Licensee’s staff, also toured the interior and exterior of the facility, and inspected all common areas and resident rooms. According to the facility’s license: The facility has a maximum capacity for six (6) residents, of whom up to one (1) may be non-ambulatory and up to one (1) more may be either non-ambulatory or bedridden. Only shared Bedroom #5, per the facility sketch, is approved to house non-ambulatory or bedridden residents. Up to two (2) residents may be under hospice care at any given time. Per LPA observation and manager interview and informed by LIC602 Physician’s Reports: During today’s inspection, there were a total of five (5) residents in care, of whom two (2) residents [Resident #1 (R1) and Resident #2 (R2)] were bedridden, which exceeds the bedridden capacity specified in the facility’s prior approved fire clearance and facility license. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] Additionally, upon LPA’s arrival at the facility, neither R1 nor R2 were occupying Bedroom #5. Only one (1) resident, R2, was under hospice care. During today’s visit, Licensee communicated with and secured consent from R1’s responsible person (RP), then moved R1 to Bedroom #5, as required. [CONTINUED ON LIC 809-C, 2 of 3] [CONTINUED FROM LIC 809] (Licensee explained that they believe R2 can turn and reposition themselves in bed; as part of the Plan of Correction, Licensee will contact R2’s physician to see if they would be willing to change R2’s status from bedridden to non-ambulatory. If the doctor does not concur, then Licensee will take legal steps to relocate R2 from the facility, which would bring the facility back in compliance with its prior approved fire clearance and facility license.) The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present. R2 had a gastronomy tube, which is a Prohibited Health Condition in the RCFE setting. Although Licensee is themselves a Registered Nurse (RN), and although Licensee had documentation that facility direct care staff had received hands-on training from a licensed professional on on gastronomy care, Licensee had not yet applied for and received an approved Exception Request from CCLD to retain R2, with this Prohibited Health Condition. Per available LIC602 Physician’s Reports and manager interview: At least four (4) of the five (5) residents in care had either Dementia or Mild Cognitive Impairment (MCI), and their doctors determined that they should not have direct access to cleaning chemicals; all five (5) residents also required facility staff to store and administer their medications, for safety. LPA observed multiple prescription medications, belonging to two residents, left unsecured/unlocked on top of the kitchen counter. Additionally, there were cold-storage medications for a third resident in the facility’s refrigerator which were left unlocked. LPA was able to touch and move said medications without the staff’s awareness, before handing said medications to staff to immediately lock up. During today’s visit, Licensee produced a locking box for those medications which must be stored in the refrigerator. Beneath the facility’s kitchen sink was an unlocked cabinet containing multiple cleaning chemicals. In the facility's laundry room, LPA observed cleaning chemicals stored next to non-perishable food; for example, a bottle of laundry detergent with a push-button spout was positioned directly above and inches away from some canned goods. During today’s visit, LPA directed staff to lock away all chemicals and to move the food to a separate storage area. The facility’s fire extinguisher was not serviced within the last twelve (12) months, as required. The smoke alarm device in Bedroom #4, which was present during the facility’s earlier fire clearance inspection, was removed/missing. During today’s visit, facility staff installed a replacement smoke alarm device in Bedroom #4. All other smoke alarms and the facility’s carbon monoxide detector were working. [CONTINUED ON LIC 809-C, 2 of 3] [CONTINUED FROM LIC 809-C, 1 of 3] In the facility’s backyard: LPA observed two (2) gardening hand spades with metal blades and one (1) container of fertilizer, left out in the open, which LPA handed to staff to lock away. There was a collection of unused medical equipment (i.e., walkers, wheelchairs, and shower chairs) that had accumulated in the facility’s backyard, which LPA directed Licensee to relocate/discard, so to not interfere with residents'/visitors’ enjoyment of the premises. Beyond this, 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 showers were working. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were present. Night lights, flashlights, and facility telephone were all working. The First Aid Kit was complete with the required contents. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There were no active fireplaces or open-faced heaters accessible to residents. No pools or bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Required licensing postings were observed in visible areas of the facility. Licensee presented proof of current business liability insurance. The facility’s ambient internal temperature was complaint at 70 F. Hot water temperature at taps used by residents for grooming were initially too hot: Bathroom #1 Sink was 125.4 F and Bathroom #2 Sink was 128.1 F. (Regulation requires them to be between 105 F and 120 F). During today’s visit, adjustments were made to the facility’s water heater settings to bring these taps back into the complaint temperature range. Refrigerators and freezers used to preserve perishable food were compliant in temperature. There was at least two (2) days of perishable food, at least seven (7) days non-perishable food present, along with cooking/dining equipment and utensils. LPA observed the following food items (which ordinarily require cold-storage) being stored outside of the refrigerator: Celery, cabbage, eggs, and a prior-opened jar of mayonnaise. LPA provided corrective education to staff during today’s visit. During a review of resident records, LPA observed, and manager interview confirmed: While R2 had a LIC602 Physician’s Report (“Medical Assessment”) that was filled out, it was not signed by R2’s physician, as required. Licensee did not have a completed LIC602 Physician’s Report for Resident #3 (R3), either. For R1, R3, and Resident #4 (R4), Licensee did not have written proof of a negative Tuberculosis (TB) test result or chest x-ray screening for the resident, which was required before move-in. [CONTINUED ON LIC 809-C, 3 of 3] [CONTINUED FROM LIC 809-C, 2 of 3] For R1, R2, R3, R4, and Resident #5 (R5), Licensee did not have the name, address, and telephone number of the residents’ dentist to be called in the event of an emergency, as required. R3 had Diabetes (a “Restricted Health Condition” in the RCFE setting, per regulation), for which staff provided support and oversight of R3’s blood sugar testing (glucometer) and Insulin administration (flex pen). However, Licensee did not have written proof that five (5) of five (5) direct care staff [Staff #1 (S1) through Staff #5 (S5)] had received hands-on training from a licensed professional on Diabetes/Glucometer/Insulin, as was required before this care for R3 began. Licensee also did not have proof/documentation that they held a meeting/conference with the responsible person and other appropriate parties for R1, R3 and R4, for the purpose of reviewing and updating the resident’s written record of care / care plan within the last twelve (12) months, as was required. Durning a review of staff records, LPA observed, and manager interview confirmed: For five (5) of five (5) direct care staff (S1 through S5) plus themselves [Staff #6 (S6)], Licensee did not maintain written proof of a completed LIC503 Health Screening (or equivalent job-related physical examination) with negative TB test result, signed by a doctor, as required before employment. S4 and S5 did not have proof of current First Aid Training, as required. Licensee did not have an employee file/record for S5, as required. Although Licensee performed two (2) disaster drills within the last year, this fell short of the frequency and variety of disaster drills described in regulation. Licensee also did not have written proof that they provided PPE training within the last twelve (12) months to S1 through S5, as required. Eighteen (18) deficiencies were cited per California Code of Regulations, Title 22, and one (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 809-D pages). Plans of Correction were jointly developed with the Licensee. Since one of the deficiencies represents a violation of the facility’s prior approved fire clearance, an Immediate Civil Penalty of $500 was charged/assessed (refer to the LIC421-IM page). Since one of the deficiencies is a repeat violation within the last twelve (12) months, a repeat violation civil penalty of $250 was also charged/assessed (refer to the LIC421-FC page). LPA also issued Technical Assistance (TA) regarding periodically measuring and recording residents’ body weights and regarding refresher training for staff on California Mandated Reporting requirements (refer to the LIC9102-TA pages). An exit interview was conducted with Licensee/Administrator Penelope Pankey, to whom a copy of this report, the LIC809-D pages, the LIC9102-TA pages, the LIC421-IM page, the LIC421-FC page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.