Routine inspection·April 29, 2026

On 04/29/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with caregiver KimIvanWilfred Budy and explained the purpose of today's visit. Currently there are 2 residents present and 2 caregivers. At 11pm the administrator/licensee arrived and met with LPA. Licensee left facility around 12 noon for an appointment at another location. The facility is licensed for age range 60 years and over. All are approved to be non-ambulatory. Hospice waiver for 3 residents. Currently there are no residents on hospice per staff interviewed. The facility ambient temperature is comfortable. There are Required postings are in place observed in main dining area. Water temperature is tested in the common hallway full bathroom measuring as 108F near room 6. Additional bathroom water temperature is measured at 110F in another full bathroom near room 4. Cleaning supplies are observed to be locked in the garage primarily. Facility knives are observed to be locked in the kitchen in a drawer adjacent to the cooking range and stove. Facility food supplies are observed to be in place with 2 day fresh food supply and canned goods fulfilling the 7 day emergency food supply. The garage has additional refrigerators with staff and resident food and additional emergency food supplies. Laundry area is observed in the garage as well and is fully operational. A tour of the outside of the facility is conducted. Emergency routes are free and clear of any obstructions. There is a locked storage shed in the backyard that contains garden supplies and furniture. Smoke detectors and carbon monoxide detectors are located through out the facility. LPA observed 3 fire extinguishers are observed in the facility with inspection dates of 10/08/2025. All are charged and ready for use. Facility conducts emergency drill quarterly per records reviewed. Continued on next page... Page 2 LPA observed all resident rooms and observed that they contain the required furniture and lighting as outlined in Title 22. Linen closet is observed in the hallway adjacent to Room 1. They are observed as in place for residents. Medications are current, locked, and logged appropriately. First aid kit is present and is filled with the required items. There are two full bathrooms, one is used as the main shower for residents, with grab bars and non-skid mats. Hygiene supplies are in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed as current. LPA observed that the facility refrigerator in the kitchen is not fully functioning and does not maintain a cold temperature. LPA measured the temperature at 76F to 77F. LPA also observed unlocked medications in the refrigerator as well in the refrigerator door. LPA reviewed 3 staff files on this day of which they are current. Staff training records are observed to be current and in place. Resident files are reviewed. 1 of 4 have half rail orders on file. 1 of 4 residents also has full bed rails with no order or exception in place. 1 of 4 residents have current appraisal needs and service plans on file. Administrator certificate for Dino Martin is observed as expired on 12/8/2024. There is a secondary administrator certificate for Mary Grace Juinio with an expiration date of 06/22/2025. LPA informed facility that annuals fees are overdue as of today's visit. The following updated items are to be received by 05/06/2026 : • Updated copies administrator certificate • Copy of facility's liability insurance • LIC500 Staff Schedule Report is reviewed with KimIvanWilfred Budy. A copy of this report is provided to the facility. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following LIC809D pages.