Routine inspection·July 1, 2025

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Lead Staff S1 Rogeine Jimenez. During the visit, LPA observed 1 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 restrooms and 3 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. During the tour, LPA observed a pool in the backyard, which was secured with a black gate, which was locked and inaccessible to residents in care. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 78 degrees F, and hot water temperature was measured at 116 degrees F in both resident bathrooms. Fire extinguisher was serviced in January 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on June 30, 2025. Page 1 Out of 2. LPA reviewed facility records for 2 staff and 2 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 1 resident. 1.LIC 500, Personnel Summary 2.LIC 308, Designation of Administrative Responsibility 3.LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. LIC200, please update (i.e., new phone numbers etc), if necessary. 6. Qualifications of Administrator (Certificate) No deficiencies cited during today's visit. This report was reviewed with Lead Staff Rogeine Jimenez and a copy of the signed report was provided. Page 2 Out of 2. END OF REPORT.