Routine inspection·October 2, 2025

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Anabelen Vallarta. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and observed there to be locked drawers and cabinets for sharp objects and cleaning supplies. LPA observed the first aid kit was complete. LPA toured five out of five bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA toured 3 out of 3 bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathrooms ranged from 110 F to 112 F. LPA tested two out of two carbon monoxide detectors and the smoke detectors in the hallways and resident bedrooms. All carbon monoxide and smoke detectors functioned properly when tested. LPA toured the outside area and found the exits were clear of obstruction. LPA reviewed the Centrally Stored Medication and Destruction Records for residents R1-R5. Resident R1 had five medications missing. R2 had three medications missing. R3-R5 did not have any medications missing. See LIC809-C page for more information. Page 1 of 2. LPA reviewed the resident records of R1-R5 and found them to be complete. LPA reviewed two staff records and found them to be complete. The emergency disaster drill log indicates the last drill occurred on 09/03/2025. LPA Marrufo requests that updated copies of the following records be submitted to the department within seven calendar days: LIC500 Personnel Report LIC308 Designation of Administrative Responsibility Liability Insurance LIC610E Emergency Disaster Plan A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Administrator Anabelen Vallarta and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORT