Routine inspection·February 23, 2026

On 02/23/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was greeted by Staff Member (SM), Vivaleene Hernandez and explained the purpose of the visit. LPA Pascua also identified a second Staff Member (SM), Shannon McGurk. LPA Pascua asked SM McGurk and Hernandez to call Facility Designated Administrator (FDA), Ricky Nolasco to inform him that CCL was present at this time. Shortly after, LPA Pascua was greeted by FDA Nolasco. This facility is licensed to serve and retain 6 elderly residents of which all may be ambulatory. This facility also holds a dementia plan on file and a hospice waiver for 3 residents. There are currently 2 residents in care obtaining hospice services. Current census was 6. A brief interview with FDA Nolasco was conducted. LPA Pascua reviewed 6 resident files. Upon review, LPA Pascua observed that the facility currently has 5 non-ambulatory residents per physicians reports on file. 6 out 6 resident files did not have a complete needs and services plan. 1 out 6 residents did not have a current LIC602 upon admission on 11/11/2025 with a current TB test. LPA Pascua reviewed 3 staff files. All staff files were complete and up to date. All staff have a current CPR/FIrst Aid certificate on file. The facility administrator has a current administrator certificate #7023411740 and expires on 09/28/2026. A tour of the facility was conducted. LPA Pascua reviewed the facility sketch and identified 4 resident bedrooms. LPA Pascua also identified the garage which has been converted into a living space for a staff member. LPA Pascua reviewed the current facility sketch with FDA Nolasco and asked for an updated facility sketch to properly identify the changes in the facility. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Medication cabinet, located in the facility kitchen cabinets, was observed to be locked and made inaccessible to the residents at this time. Along with the facility administrator, LPA compared medication to medication dispensing logs. LPA Pascua was unable to obtain medication dispensing logs for all residents. It was observed that centrally stored medication was also not completed. LPA Pascua advised FDA Nolasco of best practices and importance of keeping record of resident medication logs. First aid kit, located in the laundry room, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher that was located in the kitchen area was observed to have been annually purchased from the local Costco Company on 01/06/2026 and found to be in compliance at this time. Smoke detectors and carbon monoxide were tested and were in working condition. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non-skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308, LIC 400, LIC 500, LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated representative at this time. An exit interview was conducted and a copy of this report was provided to the administrator at the end of this visit.