Routine inspection·September 17, 2025

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Lead Caregiver, Lisa (Noveliza) Manzanilla (S1) . During the visit, LPA observed 5 residents and 2 staff. LPA explained the purpose of the visit. LPA contacted facility ADM via phone call at 10:36am, no answer. LPA left voicemail informing ADM of visit. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 restrooms and 5 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. 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 75 degrees F, and hot water temperature was measured to range from 108-112 degrees F in resident bathrooms. Fire extinguisher was serviced in January 8, 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 August 18, 2025. S1 stated that was the only drill conducted in 2025. Page 1 Out of 2. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 1 residents. LPA requested a copy of the following documents be sent to LPA by September 24, 2025 1. LIC500, Personnel Summary 2. LIC308, Designation of Administrative Responsibility 3. LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. Qualifications of Administrator (Certificate) Deficiencies are being cited during today's visit. This report was reviewed with Lead Caregiver, Lisa (Noveliza) Manzanilla and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORT.