Routine inspection·October 15, 2025

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Michael Vu. During visit, LPA Marrufo toured the facility inside and out. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed there to be locked cabinets and drawers for cleaning supplies and sharp objects. LPA Marrufo toured three out of three resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured between 108 F to 118 F. The bathroom showers had anti-slip mats and shower chairs. LPA toured five out of five resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA tested the smoke detector system and it functioned properly when tested. LPA tested the carbon monoxide detector and it functioned properly when tested. LPA toured the outside area of the home and the outdoor exits were clear of obstructions. LPA reviewed the Centrally Stored Medication and Destruction Records (CSMDRs) of five out of five residents. Resident R1's CSMDR had one medication that did not have it's prescription number recorded. R2's CSMDR had four medications that were not recorded. Staff recorded the missing medication information during visit. See LIC809-C page for more information. Page 1 of 2. LPA reviewed five out of five resident records and found them to be complete. LPA reviewed three staff records and found them to be complete. LPA reviewed the Emergency Disaster Drill Log and found the last drill was recorded on 10/01/2025. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. LPA Marrufo requests that updated copies of the following documents be updated and sent to the department within seven calendar days: LIC500 Personnel Report LIC308 Designation of Administrative Responsibility Liability Insurance LIC610 Emergency Disaster Plan This report was reviewed with Vicky Ablao and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORT.