Routine inspection·June 13, 2025

On 6/13/2025, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Lead Caregiver, John Guintu. Licensee, Nancy Uy was notified of the visit but was not able to attend. The facility currently provides care for 3 residents none of which with a current diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located in the kitchen was found to be charged. Smoke detector were observed in resident bedrooms tested. LPA observed a carbon monoxide detector in the hallway to be non-functioning and in need of replacement. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate coverings, enough for residents in care. There was a supply of hygiene products and paper products available for residents. Resident's bedroom have lighting & appropriate furnishings and bedding items. Restrooms for resident use were equipped with non-slip mats, grab bars and kept in good condition. There is a large outdoor patio equipped with appropriate shading for resident use. LPA conducted a sample file review for residents found that 2 of 3 residents do not have physician's reports on file and 1 of 3 residents does not have a needs & service plan on file. Upon a sample review of staff files LPA found that 1 of 2 caregiver staff do not have current 1st aid & CPR certification on file. Upon interview with resident (R1), it was stated that the facility staff do not provide any supplies for activities or engagement. LPA observed an unplugged television in R1's room and found that the television is not connected to basic television channels compared to other residents in care. R1 stated that they aren't encouraged to participate in any exercise or activities while under the facility care. Continued onto LIC809-C LPA will return at a later date for the purpose of an annual continuation visit to review medications, staff training and emergency response records. Administrator, Nancy Uy is in the process of updating their administrator certification Acting Administrator, Joanna Casandra Uy's administrator certificate 7035656740 is valid through 9/29/2026 LPA requested the following documents be sent to CCL by COB 6/20/2025: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.