Routine inspection·March 26, 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. LPA Rai observed 2 staff 4 residents at the facility as 1 resident is out of the facility. 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 2 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 115.5 - 118.2 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 03/10/2026.  LPA Rai observed a complete first aid kit at the facility. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed facility records for 2 residents. During review of R1's facility records, R1's Appraisal/Needs and Services Plan dTED 04/2025 and Theft& Loss Policy was not signed by resident or resident's responsible party. LPA Rai reviewed facility records for 2 staff. During review of S1's facility records, S1 did not have an signed SOC 341A Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders and Health Screening Record was not on file. LPA Rai reviewed resident medications and central stored medication records. During review of resident R2's medications, 1 out of 6 medications (MED1) was not recorded on Centrally Stored Medication Records and R2 has signed physician's orders for MED1 and ADM stated staff are currently administering the medication to R2. A civil penalty is being assessed for the amount of $250 for repeat violation for CCR 87465(h)(6) for licensee did not assure that a record of centrally stored prescription medications for each resident is maintained for at least one year wherein resident R1's medication was not recorded on the Centrally Stored Medication Log. See LIC421FC. 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. 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.