Routine inspection·September 22, 2025

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Administrator Josephine Yong. During visit, LPA toured the facility inside and out. LPA toured the kitchen area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA reviewed the first aid kit and found it to be complete. LPA Marrufo toured 9 out of 9 resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA toured three out of three resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks ranged from 114 F to 120 F. LPA tested the carbon monoxide and smoke detectors in the hallways and bedrooms. Each detector functioned properly when tested. LPA toured the outside area and found the exits to be clear of obstructions. See LIC809-C page for more information. Page 1 of 2. LPA reviewed the Centrally Stored Medication and Destruction Records (CSMDR) for 6 residents. 4 out of 6 CSMDR were complete. Resident R1's CSMDR was missing one prescribed medication. R2's CSMDR was missing 1 prescribed medication. LPA reviewed 6 resident records and found them to be complete. LPA reviewed 6 staff records. Four out of six staff records were complete. Staff S1-S2 were missing current first aid certifications. S2 was missing a health screening form. The emergency disaster drill log indicates the last drill was conducted on 07/05/2025. LPA Marrufo requests that updated copies of the following documents be submitted to the department within seven calendar days: LIC500 Personnel Report LIC308 Designation of Administrative Responsibility Liability Insurance LIC610E Emergency Disaster Plan Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D pages for more information. This report was reviewed with Administrator Josephine Yong and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORT