Routine inspection·October 28, 2025

On October 28, 2025, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA met administrator, Ruth Gripo and caregiver, Johanna Belleza and LPA explained the purpose of today's visit. LPA toured the facility inside and outside including the bedrooms (4 private rooms), 2 full- bathrooms, kitchen, 2 living and dining rooms. The facility observed to be cleaned, and tidy. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid tile. Facility temperature is comfortable. Hot water temperature in the bathrooms were measured at 105-108 F degrees. Central stored medication, toxins and sharps objects were observed to be locked and inaccessible to residents. During the tour of the facility, LPA observed chipped paint in the common area, kitchen, resident rooms, etc and broken baseboard throughout the facility. Emergency drills, and staff training records were reviewed. Food supplies were observed to be adequate. Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguisher was last serviced on May 14, 2025. LPA reviewed P & I records for 3 residents to be adequate. A review of (3) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. LPA requested for a copy of the lease agreement to be submitted by 10/31/25. 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 administrator, Ruth Gripo. A copy of the report is provided and appeal rights.