Routine inspection·July 14, 2025

Unannounced annual visit made out to this facility on 07/14/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff persons, Raquel Ramos and Rowena Andres, who were briefly interviewed at this time. This LPA requested that they go ahead and contact the facility designated Administrator, Emma Villamil, to inform her that CCL was present at this time for an annual visit. Current census was 4 residents. It was learned that this facility had (3) residents receiving care under hospice care at this time. This facility does have an approved hospice waiver to be able to accept and retain up to (6) residents at any given time. It was learned that there were (4) residents diagnosed with dementia at this time. This facility has, on file, a program to accept and retain residents diagnosed with dementia at this time. It was learned that there were (2) residents deemed to be bedridden at this time. This facility does have an approved bedridden fire clearance to be able to accept and retain up to (2) residents in bedrooms 5 and 6 at this time. Tour of the facility was conducted. Living area, dining area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient, in good repair, and able to meet the needs of the residents at this time. Kitchen area was toured. Cabinets and drawers were opened and the contents were reviewed at this time. Items for preparing, cooking, and serving meals unto the residents were observed to be sufficient and in compliance at this time. Cleaners and cleaning agents were observed to be locked and made inaccessible to the residents at this time. Fire extinguisher, located hanging on the wall adjacent to the refrigerator, was observed to have been annually purchased from the local hardware store and in compliance at this time. Medication cabinet located in the front entry closet was observed to be locked and made inaccessible to the residents at this time. First aid kits were observed to be present and contained all of the required components at this time. Food supply, and food storage units, were observed to be sufficient and able to meet the needs of the residents at this time. This facility was observed to have, on hand at all times, a sufficient supply of 2-day perishable and 7-day nonperishable food quantities at this time. A tour of the facility bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the facility restrooms was conducted. Grab bars, non skid mats, and toiletries were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees at this time. A review of the laundry room was conducted. Bleach, detergent, and all other laundry supplies were observed to be locked and made inaccessible to the residents at this time. Garage area was toured. It was observed that this area was used mainly to store facility related items at this time. Exterior grounds of this facility were toured. Facility perimeter fence, side gates, and all other exits were reviewed at this time. Administrator certificate for the facility designated Administrator, Emma Villamil, was observed to be present with certificate number #700938740 and set to expire on 05/07/2026. A review of (3) facility personnel files was conducted and noted on the following LIC 859. A review of (4) facility resident files was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL: 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 representative at this time. Exit Interview