Post-licensing visit·January 28, 2026

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced post-licensing inspection visit. LPA met with Licensee (LIC) Rene Clemente. Administrator Aries Geronimo was not present at the facility at the time of the visit and arrived shortly thereafter at around 9:10 a.m. The facility is licensed to serve adults age 60 and over. Approved for six (6) non-ambulatory of which one (1) may be bedridden in Room #1 or Room #3. Garage is off limits, Level 2 is off limits. The facility has a hospice waiver for two (2). LIcensee accompanied LPA during inspection of the facility. LPA observed the following such as but not limited to poster of If You See Something Say Something, personal rights, facility license in a visible area, menu, staff tasks, calendar, emergency call list, emergency disaster plan, and resident roster. LPA inspected 3 resident bedroom, garage, kitchen, dining area, living area. LPA inspected the facility exterior area. Hallways, walkways, exit routes was observed to be free from tripping hazard and not obstructed. Sharp objects, medications, chemicals, and disinfectants observed in a locked cabinet. LPA observed 4 residents at the time of the visit. 1 Out of 4 was observed in the living area watching TV, 2 out of 4 was observed in the dining area having breakfast and 1 out of 4 was inside his/her room watching TV. LPA observed 2 staff (S1 and S2) busy doing chores and assisting residents. page 1 of 2 see LIC 809C Facility temperature maintained at 70 degrees F. Resident bedrooms observed with beds, linens, adequate lighting, storage spaces for personal belongings. 2 out of 2 resident bathrooms were observed to have grab bars and anti skid mats. Water temperature maintained between between 111.5 to 117.3 degrees F. Facility has a sufficient supply of extra linens. Facility refrigerators temperature maintained at 40 degrees F. Freezer temperature maintained at 0 degrees F. LPA observed at least 2 days worth of perishables and 7 days worth of non-perishables food. LPA reviewed 4 resident and 4 staff files were maintained to include a medical assessment, TB result, appraisal/needs and services plan, safeguard of personal property and valuables, admission agreement, personal rights, and consent forms. 4 out of 4 residents centrally stored medications were reviewed. LPA observed that 4 out of 4 Centrally Stored Medication Record does not match the prescribed medications in the inventory. PRN medications were not written in the centrally stored medication record. LPA reviewed 4 staff records and 3 out of 4 staff record did not have the health screening record, 2 out of 4 did not have proof of TB test. 4 out of 4 staff record has fingerprint clearance and 1st aid certificate and updated training. LPA provided technical assistance to licensee and administrator for keeping accurate record of staff file and resident files and other corrections that needs to be addressed by the licensee and administrator. No deficiencies were cited during today's visit based on California Code of Regulations (CCR), Title 22. An exit interview was conducted with Licensee Rene Clemente and Administrator Aries Geronimo. A copy of the report was provided. page 2 of 2 end of report