Routine inspection·February 25, 2026

On 02/25/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced Annual Required – 1yr. inspection for this facility and was greeted by administrator/licensee Lilibeth Jacobs. The facility currently provides care for 5 residents, and 3 staff. Facility is licensed for ages 60 and over. 6 residents may be non-ambulatory and 1 bedridden resident. There are no residents that are bedridden. There is a hospice waiver on file for 3 hospice residents. As of today's visit, there are no residents on hospice. This is a single level facility with 6 resident bedrooms. LPA toured the facility with Lilibeth, and the facility is found to be clean and at a comfortable temperature with all emergency exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas are inspected. LPA observed 2 fire extinguishers located through out the facility. All observed are charged with inspection tags of 11/03/2025. LPA observed the kitchen, garage, and laundry are are found to be in operable condition, organized, and clean. Carbon monoxide detectors are located through out with combination smoke and fire detectors that are hard wired through out. Resident restrooms and full bathrooms are observed at random. Showers are equipped with non-skid flooring or mats and grab bars for accessibility. Water temperature is tested in two resident full bathrooms at 116F and another is measured at 115F. Resident bedrooms are observed to be fully furnished with items outlined in Title 22 and all furniture is in good condition. Linen closets are observed to be fully stocked with supplies for residents. Continued on next page... Page 2 There is sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen and garage being sufficient for residents in care. Food supply is replenished regularly. There are additional refrigerator and freezer in the garage and both are observed to be fully stocked with resident food supplies. Cleaning supplies and other toxins are safely stored in locked closets in the garage and kitchen. There is a supply of hygiene products and paper products available for residents. Medication cabinets are observed in the kitchen as locked not accessible to residents in care. PPE is observed as stored and in place in the garage and gowns being stored in an exterior facility storage shed. A random audit of medications is conducted and found that all medication counts and records are in order. LPA conducted a sample file review for residents and found all items to be in order including medical assessments and needs & service plans. Upon review of staff files, LPA found that caregiver staff have annual training and current 1st aid and CPR on file and current. Last disaster drill conducted was in 12/16/2025 which was an earthquake drill. Administrator certificate is observed to be current expiring 01/16/2027. No deficiencies cited during today's visit. Report is reviewed with Lilibeth and a copy is provided.