Routine inspection·December 18, 2025

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Required 1-Year inspection visit. LPA met with the Administrator, Michelle Benitez and stated purpose the visit. The facility is licensed to serve adults 60 and over, 6 ambulatory and 6 out of 6 may be non-ambulatory and a hospice waiver for 5. The facility has a current census of 5. At the time of the visit (0800), one staff and administrator was busy assisting resident with their activities of daily living (ADLs). LPA was accompanied by the administrator during inspection of the facility inside and outside. LPA observed exterior walkways were free from any obstruction ramps and railings. The back ramp was observed to have some signs of wear and tear. A gazebo was observed and items were stored in the gazebo, such as tables, propane gas tanks, cat scratchers, some chemicals on the table, cat food on the table, some gardening tools to name a few. LPA observed a sack of plant food/fertilizer. ADM stated the gazebo is not used by residents during winter season. In the summer time, the gazebo is cleaned and de-cluttered for resident's use. LPA inspected the garage and laundry area, found the laundry area unlocked. Laundry detergents were observed on top of the shelves above the washer and dryer. Washer and dryer were in good working condition. The garage was organized and has a walkway that was not obstructed. LPA inspected the interior of the facility and observed that hallways were free from obstruction and free from tripping hazard. The hallways were well lighted. 5 out of 5 resident bedrooms are sanitary and organized, furnished with dressers, chairs and tables that are sufficient to store resident's personal belongings. LPA observed that 5 Out of 5 residents are non-ambulatory, at the time of the visit 2 Out of 5 residents were awake and 3 Out of 5 were in bed resting. page 1 of 3 - continued to LIC 809 C LPA inspected 2 resident bathroom and found it clean, sanitary, with hygiene supplies. Bathroom were equipped with grab bars, non-slip floor, a shower chair, and a raised bathroom seat. The hot water was measured with a digital thermometer. Water temperature for both bathrooms measured at 137.6 to 139 degree F. LPA inspected the dining area and living area and observed gifts bags the floor at the corner end of the table was piles of papers, set aside to make room for Christmas decorations. The living area has gift bags and items to be wrapped for the holiday season. The couch has gift items, and gift wrappers on top. ADM stated that they are in the process of wrapping gifts for the coming holiday to be distributed. LPA inspected the kitchen, and observed that the kitchen was sanitary. The kitchen counter has food items such as bread, tray of 30 eggs sealed, cookies, a box of corn dog, food on top of the stove covered with glass lids, a container of meat on top of the corn dog box. A container of take out food that was eaten and left on the counter top, fresh produce on the corner left side of the kitchen counter and a crate of fresh produce on the kitchen floor (photos taken). A LPA observed an upright refrigerator/freezer combination, with 2 days of perishable items. The refrigerator temperature measured at 38 degree F and the freezer measured at 0 degree F. Water temperature measured at 133 degree F with a digital thermometer. LPA observed a drawer with the key containing the sharps and knives that was unlocked and no staff was present. LPA observed 7 days of non-perishable items. The facility is equipped with a working smoke and carbon monoxide alarm a fire extinguisher (last inspected 09/30/2025). First aid kit with the guidebook. Emergency disaster training, fire and earthquake drill was administered on January 2025 and no subsequent drills and training were administered. LPA reviewed 5 out of 5 resident file record and observed the following, 3 out of 5 are missing the consent form, 2 out of 5 has incomplete or missing client's personal valuables (LIC 621), 1 out of 5 is missing proof of TB testing, 2 out 5 does not have the appraisal needs and services plan, 5 out of 5 does not have the weight record. 5 Out of 5 resident record has complete and updated Centrally Stored Medication & Destruction Record (CSMDR). LPA reviewed 3 out of 3 staff record and observed the following; 3 Out of 3 Staff are missing the SOC341A (mandated reporter) 1 out of 3 is missing the LIC 503 (health screening), 1 out of 3 training was last administered on 07/07/2024, 1 out of 3 is missing the LIC (501) personnel record/job application. page 2 of 3 - continued to LIC 809C Based on observation and record review following were observed that may pose an immediate or potential risks to persons in care. The water temperature measured from 133.1 to 139.7, food safety and storage the laundry area was unlocked, laundry detergents were observed. At exterior area; gazebo contains chemicals on top of the table, gardening tools and potting soil. The ramp by the back side is showing signs of deterioration. LPA observed unlocked drawer containing knives and sharps and no staff was present in the kitchen. LPA suggested to LIC/ADM to reach out to the department's Technical Support Program (TSP). The TSPs are non-enforcement programs of CCLD and provide services, training, and resources to support providers in meeting licensing requirements. Deficiencies are cited during today' visit based on California Code of Regulation (CCR) Title 22, other deficiencies were issued technical violations based on what was observed and the severity of the deficiency. (See LIC 809D). An exit interview was conducted with licensee/administrator Michelle Benitez. A copy of the report and appeals rights were provided end of report page 3 of 3