Routine inspection·September 25, 2025

Licensing Program Analyst (LPA) Maria (Mita) Partoza a conducted an unannounced required 1 year inspection visit and was greeted by Rex Deocales- House Manager (HM). Rosario Arellano, LIcensee/Administrator (LIC/ADM) was not present due to prior commitment. LPA stated the purpose of the visit. The facility is licensed to serve adults 60 and over. 1 may be bedridden and hospice waiver for 6. 3 Out of 5 are under hospice care. 6 Out of 6 are non-ambulatory, 6 out of 6 have neurocognitive disorder. 3 Out of 6 are under hospice care. LPA observed 5 residents and 3 staff were present at the facility at time of the visit. At 1:45 p.m. LPA toured the facility inside and outside with HM including but not limited to the kitchen, bathroom, dining room, living room, 6 residents rooms, garage, backyard and exterior walkways. Walkways and hallways are free from obstruction. The exterior side walkways are free from obstruction and gates have audible alarms to alert staff. The temperature inside the home was at 71 degrees Fahrenheit. The kitchen and bathroom water temperature measured at 110.1 to 111.5 degrees Fahrenheit. The kitchen was observed to be sanitary and organized, knives and sharps were locked and not accessible to residents. The bathroom/s are equipped with grab bars, non-skid mats. Resident's room (R1 to R6) have sufficient storage. Residents room are sanitized and organized. Rooms 3,4 & 5 have exit door/sliding doors with audible alarms to alert staff. Under the sink cabinet is used to store cleaning supplies and locked and not accessible to residents. LPA observed 2 days of perishable food and 7 days of non-perishable food and are labeled with date purchased or date of expiration. The refrigerator temperature is at 32 degree F and freezer is at 0 degree F. The first aid kit is complete and is accessible to staff. The washer and dryer located in the garage are in good working condition. Laundry soap and cleaning supplies are locked and not accessible to residents in care. The facility is equipped with a fire, smoke and carbon monoxide alert system that is in good working. Night lights were observed on the hallways. Floors are maintained an free from tripping hazard. The facility is equipped with surveillance camera in the dining, kitchen, living area, entry way, and the front exterior. ADM stated the cameras do not record, does not have audio and no data are being collected. A consent form was signed by responsible parties. LPA reviewed the facility disaster preparedness training, and found that training was last administered on 06/13/2025. LPA requested copies of the LIC 500, liability insurance and LIC 308. Fire extinguisher was last inspected on 07/07/2025. LPA reviewed 3 resident records such as but not limited to the centrally stored medication and destruction record (CSMDR), admission agreement, needs and services plan, health screening and observed records are complete and updated. LPA reviewed 3 staff records including but not limited to required training, first aid/CPR training, health screening and background clearance. All staff have criminal record clearance/fingerprints and records are complete and updated. No deficiencies were cited during today's visit, based on California Code of Regulations (CCR) Title 22 An exit interview was conducted with House Manager (HM) Rex Deocales and a copy of the report was provided. page 2 of 2 end of report