Routine inspection·April 7, 2026

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Administrator, Carmen Buno and stated the purpose of today's visit. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 1 shed in the backyard which was locked and used for storage and not habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 6 resident rooms, 1 staff room, living room, dining room, kitchen and garage. 6 Out of 6 resident bedrooms had available bedding, drawers, and functioning lights.  The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 109.2 - 109.4 degrees F. Fire extinguisher was observed and inspected on 01/07/2026. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills were conducted on 12/20/2025 and 03/11/2026.  LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 2 staff and 2 residents. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed at random 2 residents' medications and central stored medication records. LPA Rai reviewed resident R2's 10 medications and observed 1 out of 10 medications (MED1) was not logged on the Centrally Stored Medication Record. LPA Rai and facility staff S1 Patricia counted the medication tablets in MED1 bottle and 194 tablets were counted. The medication bottle was opened and the medication was administered from the bottle on 04/03/2026. LPA Rai and facility staff S1 reviewed R2's Medication Administration Record for MED1 and observed staff initials for medication administered from 04/03-04/06/2026. LPA Rai observed on 04/5/2026 the staff's initials and the circle around the initials. S1 stated those are her initials and the circle around the the letter "R" means the resident refused. LPA Rai observed R2's MARs and there were staff initials and then a letter R and a circle was created on top. Administrator Carmen Buno stated the staff should not sign off on the MARs before administering the medication as the resident may refuse the medication, which happened in this case where in R2 refused the medication after S1 signed on the MARs stating the medication was administered to the R2. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Technical Violations was provided. This report was reviewed with Administrator, Carmen Buno and a copy of the report was provided. LIC 858 and LIC 859 were provided. Appeal Rights was provided.