Routine inspection·December 2, 2025

On 12/02/2025, Licensing program Analyst (LPA) Jaime Vado conducted an unannounced required - 1 year inspection. LPA met with Administrator Corina Ancheta and explained the purpose of today’s visit. All residents are present in the facility and 3 staff are present at time of the inspection. This is a single level facility. The facility is licensed to serve 6 non-ambulatory adults ages 60 and over to which 1 may be bedridden. License is subject to the terms of the hospice waiver for 3 residents. Currently there is one resident on hospice. LPA Vado toured the facility both inside and outside. All outdoor and indoor passageway are free and clear of obstructions for emergency exit routes in case of fire or emergency. Facility's ambient temperature is comfortable for residents and LPA. No pools or bodies of water were observed during today's visit on the premises. LPA observed fresh food supplies and emergency one week of nonperishable and 2 days of perishable foods as in place. Knives are locked in the kitchen in a drawer beneath the cooking range. Toxic chemicals are stored in a locked cabinet below the kitchen sink. Centrally stored medications are locked in a cabinet resembling a medication cart adjacent to the garage door inside of the facility. LPA observed all resident rooms as clean, free of odors, and contained all the required furniture per regulatory recommendations. Facility has functioning smoke detectors and carbon monoxide detectors within the facility. Continued on next page... Page 2 The facility is equipped with two full bathrooms for resident use, which are in good working order. Shower floors are equipped with non-skid mats. Water temperature is tested at 105F in one of the resident bathrooms. LPA observed 2 fire extinguishers within the facility. Both observed as charged and ready for use per the dial reading on the extinguishers with an inspection tag of 01/10/2025. Last fire and earthquake drill were both conducted on 07/2025 per staff but it was not logged. Other drills were logged per observations made. LPA reviewed 6 resident files and 3 staff files, which are all current. Facility administrator certificate is observed as current expiring on 03/05/2026. No citations are issued during today's visit but a Technical violation is provided on the attached LIC9102TV. Report is reviewed with the administrator and a copy of this report is provided.