Routine inspection·October 2, 2025

On October 2, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. Upon entrance, LPA was greeted by caregiver Delilah Nicodermus and LPA explained the purpose of the visit. House Manager Rosita Padolina and Administrator, Katie Eiseman arrived shortly thereafter and assisted with the annual inspection. The facility is licensed for a capacity of 6 non-ambulatory residents of which 3 may receive hospice care services. There are 2 residents receiving hospice services at this time. LPA toured the facility inside and outside including the bedrooms (4 private and 1 shared rooms), 1 full- bathroom, kitchen, living room and common areas. Staff rooms are located on the 2nd floor. The facility observed to clean, tidy and in good repair. Bedrooms were equipped with the required furniture for residents to use. Bathroom is equipped with grab bars, and in good condition. Facility temperature is comfortable. Hot water temperatures in the kitchen and bathroom was measured at 105- 110 degrees F. LPA observed 2-day perishables and 7-day non-perishables. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors in the facility. Fire extinguishers were last inspected on 8/8/2025. Medication, and disinfectants were observed to be locked and inaccessible to residents. At 10:20AM, during the facility tour with the house manager, LPA observed the sharps that were stored in the kitchen drawer was unlocked. A review of (6) resident files was conducted and noted on the LIC 858. A review of (4) staff files was conducted and noted on the LIC 859 and LPA observed Staff #1 (S1)'s Criminal Record Clearance transfer was incomplete. The administrator will provide a copy of the Liability Insurance to CCL by 10/3/2025. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with the administrator and the house manager. A copy is provided and the appeal rights.