Routine inspection·September 24, 2025

At 12:05pm, on 9/24/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee/Administrator Evelyn Florentino, announced who he was and the reason for the visit. Licensee/Administrator and LPA conducted a full tour of the facility. This facility is a single story residential home with four resident bedrooms (two are dual occupancy), two full bathrooms (one is on-suite and one is for public/shared use). There is a living room, dining room, and a kitchen. The dining room has a piano for residents and visitors to enjoy. LPA noted a fireplace in the dining room, the Administrator states is not used. Access to the laundry room is through locked bi-fold doors for resident safety. The garage is through a locked door also for resident safety. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy. The facility has wired smoke detectors in each room that are all working, the Great Western Alarm technician was actively testing the smoke detectors and alarm system during the LPA visit. The carbon monoxide detector is in the entry under the visitor log and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 1/14/2025. LPA tested facility hot water at 110*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. LPA noted that the facility is clean with no obstructions in hallways, doorways or exits. Medications are locked in a medication cart. (Continued on LIC809-C) Staff and client files are locked near the living room. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding 3 of 4 resident's medications managed by the facility not logged on the centrally stored medication record as required by Title 22 regulation. LPA conducted a staff and resident file review. LPA and Licensee/Administrator conducted a review of the annual care tool modules. Exit interview conducted, deficiency cited on LIC809-D page, report signed, appeal rights and report provided to Licensee/Administrator.