Non-compliance follow-up·January 14, 2026

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced case management - legal/non-compliance visit (NCC) and met with Administrator/Licensee (ADM/LIC) Bernellet Taa. The purpose of the visit is to ensure the facility is adhering to the compliance plan submitted to Community Care Licensing (CCL) after a non-compliance meeting held on 07/26/2024. During visit, LPA toured the facility inside and outside and accompanied by ADM/LIC the living room, kitchen, dining room, 3 resident bedrooms, resident bathroom, staff room, Administrator's office, and backyard. No cameras were observed inside the facility. The interior of the facility is maintained, organized and sanitary. LPA observed 2 staff (S1 & S2) working upon arrival and observed 2 residents watching TV. The exit door leading to the backyard and entrance door observed with a door alarm. Staff demonstrated how to operate the door alarms, in which LPA observed the alarms were in good working condition. The facility has no surveillance camera outside. LPA reviewed the facility scheduled activity calendar with corresponding activities for each day of the week. LIC/ADM stated 2 Out of 4 residents are able to leave the facility unassisted, are able to drive and have valid driver licenses. 3 out of 4 are in the facility, and 1 out of 4 is out attending prior commitments. Activities listed on the calendar are to promote the resident's mental, emotional and social functions of the residents in care. page 1 of 2 See LIC 809C LPA inspected 3 resident bedroom 3 Out of 3 bedroom are shared, with storage for resident's personal belongings, resident bathroom, staff room and office room. Resident bathroom has grab bars and anti skid mats, sanitary and organized. 1 out 3 bedroom is set-up for bedridden and non-ambulatory individuals. Licensee is approved for 3 ambulatory, 2 non-ambulatory and 1 bedridden. LPA reviewed the facility's LIC500, the facility has 2 main caregivers who lives at the facility. S1 and S2 are able to respond in case of an emergency. LIC/ADM is at the facility at least 20 hours per week. LIC/ADM stated that S1 as the main administrator of the facility and LIC/ADM will be a back-up administrator. There are two individuals listed on the LIC 500 that are family member of the licensee and staff. Both individuals are background and fingerprint cleared. LPA reviewed 4 Out of 4 resident files and verified that records are current and updated such as but not limited to appraisal/needs and services plan, admission agreement, medical assessment, TB result, and signed personal rights forms. The resident's appraisal/needs and services plan have detailed information of the residents' care needs with the corresponding action to meet their needs. LPA reviewed 2 staff files. The 2 main staff members (S1 and S2) has current active 1st aid certification and updated training on topics to include such as but not limited to medication training, Alzheimer/dementia care, nutrition, and caregiver staff training. Staff health screening is complete and has cleared TB test. LPA reinforced the importance of adhering to the facility's corrective plan of action developed on 07/26/2024 to LIC/ADM to ensure that the facility stays in compliance with California Code of Regulations (CCR) Title 22. LIC/ADM was reminded that the facility will be monitored for the next two years from the date of the NCC meeting starting 07/26/2024. No deficiencies were cited per California Code of Regulations, Title 22. An exit interview was conducted with Administrator, Bernellet Taa and a copy of the report was provided. page 2 of 2 end of report