Routine inspection·January 28, 2026

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to conduct the annual inspection, LPA met with the Facility Administrator Cecelia Reyes. the facility is licensed for 6 nonambulatory one of which may be 1 bedridden. There are 1 client has o2 administration, 2 have diabeites, 3 have dementia. 3 are non-ambulatory. There is not an exception on file for the o2 administration insulin dependant diabetes, Administrator will work the LPA to file the exeption paperwork, begining with a formal request for an exception to be recived by the LPA in writing, noel.wolfpetersen@dss.ca.gov by end of day tomorrow 1/29/2026 Physical inspection includes a converted garage, there are 4 rooms, Bedridden room on the facility sketch is designated as room 3 or room 4. Physical inspection included the kitchen, bedrooms, bathrooms, common areas, storage areas, exterior, and evacuation route gate. Evacuation route gate is obstructed by a heavy spring that renders an unnessisary resistance to opening the gate more than a 20*, LPA is asking the spring to be reinstalled to a position where the door could be opened 90*, or be removed. Administrator adjusted the spring tension. Fire extinguisher is dated 10-17-25. CO/smoke alarm is functional, water temp is measured at 114.5*F. LPA interviewed 1 client, 1 clients is out of the facility, 1 client retired for the evening. LPA interviewed 1 staff. Continued C-Page. Admin files were reviewed, including but not limited to: admin certificate(expiring 5.8.26), LIC 500(Staff schedule has 17 hours of coverage week days, week nights seems to have a 7 hour vacancy from 11pm-6am, staff schedule has 9 hours of coverage on the weekends, weekends seem to have a 15 hour vacancy from 3pm-6am), Aministrator provided there she and her husband are live in monday to friday, 1 additional staff is to be hired, LPA gave guidance night supervision requires on call on premises staff, and staff should have 5 hours of break between shift. LIC 9020(client Roster), Hiv Training, Fire drill record, Emergency preparedness, Infection control Plan, required posters(Personal rights, Ombudsman, facility license, facility sketch), and Plan of Op(control of the property via grant deed, surety bond(no bond) and liability insurance) are up to date and present. Client files were reviewed, including but not limiting to: recent medical assessments, admission agreements, functional capability assessments, and needs and services plans. Client exhibt restricted conditions: o2 administration due to copd, insulin dependant diabedies, facility does not have these services covered in ammendments toPlan of Op or having adequate trainings(4 hours per) for staff. Lpa gave guidance that more of the yearly training should be devoted to the following topics: wandering, diebetes, 02 administration. Needs and services plans read as the same for folks and are unfilled out in some portions. LPA gave guidance to contextualize needs and services plan to the specific needs of the clients. Admission agreement contains prohibited terms(refund conditions only allow for 15 days of basic services after the death of the resident.) LPA gave guidance that terms meet admission guidlines. LPA is requesting a copy of the updated admission agreement and the needs and services plans 2/5/26. Staff files were reviewed, including but not limited to: first aid training, continuing education, and criminal background check, health screening. Most annual training records are due for January, some records are out of date by a few days. Staff training is inadequate for restricted condition care, staff should have 4 hours annually for each restricted condition. LPA gave guidance to seek a licensed medical service provider outside her current employ to run an inservice for the restricted condition care for all employees. no citation was issued, a copy of the report was given. Exit interview was conducted.