Follow-up on corrections·March 25, 2026

On 03/25/2026, Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced visit to address a complaint that was filed with the Department on 03/17/2026. This case management is not part of the complaint. This case management - deficiencies is based on LPAs observation at the time of the visit. During the visit LPA was accompanied by the designated administrator Philipp Perez. Licensee/Administrator (LIC/ADM) David Devries is not available at the time of the visit due to prior commitment. The facility is licensed to serve adults age 60 and over with a capacity of 6, of which may be ambulatory and 6 may be non-ambulatory and a hospice waiver for 6. LPA conducted inspection inside and outside, including but not limited to the kitchen, dining area, 4 out 4 resident bedroom, 2 out 2 bathrooms, 1 staff room, exterior perimeters, and interior area of the facility. During inspection, LPA observed no tripping hazard on the hallways and emergency exits. LPA observed Arm and Hammer laundry detergent and Downy liquid cloth softener not locked in the laundry area that is located in the pass through from the inside towards the garage area and accessible to residents in care. S1 stated one of the resident likes to do their laundry at night that's why they leave the detergents inside the cabinet and not locked. LPA observed a steak knife that was not locked and is accessible to residents in care in the left corner drawer of the counter located in the kitchen. LPA observed the kitchen vent was covered with accumulated oil residue. page 1 of 2 see LIC 809C LPA observed the screen of the sliding door was frayed and has a hole that can fit a hand (Room #3). The facility has a side ramp and a ramp at the back to accommodate non-ambulatory individuals. The ramp's railing is not sturdy when touched lightly. LPA observed a green colored lighter on top of a table next to an frayed upholstered arm chair located at the back of the property by the exit sliding door. LPA observed frayed upholstered recliner next to the back ramp railing a chair that is broken next to the fence, and a power lifting press bench with frayed leatherette cover, cobwebs and rust. LPA inspected 5 bedrooms, 4 are for residents and 1 is for staff. 2 out of the 4 are shared and 2 are not shared. 1 out of the four has a bathroom and 1 shared bathroom in the hallway. The bathroom are equipped with grab bars and anti-slip mats. A sign that residents are not allowed in the garage is visible and door is kept closed and locked. LPA observed a carbon monoxide alarm system and a broken smoke alarm system at the entry hallway. The facility has 2 days of perishable food and 7 days of non-perishable foods. LPA observed a fire extinguisher that was last inspected on 08/12/2025 located near the kitchen, a dried pumpkin by the fireplace was also observed. LPA observed 3 out of 6 residents having breakfast on the dining table. LPA covered clear plastic container with each person's name written on a sticker. 2 out of 6 was asleep and 1 out of 6 was outside. When asked what is inside the clear container. The 3 residents and 2 out of 3 staff stated that the container is used for resident's medications. Staff 1 (S1) stated that the medications for breakfast are pre-poured or pre-prepared in the evening and given during breakfast. LPA reviewed 2 out of 2 staff record. 2 out of 2 staff have cleared criminal background and fingerprint record and are associated with the facility. 1 out 2 staff have a 1st Aid/CPR certification that will expire on June 08,2026. 1 out of 2 staff was recently hired and is currently in training. LPA reviewed 4 out of 6 resident record, the records were complete and up to date. Deficiencies are cited during today's case management - deficiencies based on California Code of Regulations (CCR) Title 22 See LIC 809D. An exit interview was conducted with designated administrator (DADM) Philipp Perez. A copy of the report and appeal's rights were provided. page 2 of 2 end of report