Inspector’s narrative
What the inspector wrote
On July 25, 2025, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrators, Kendall Hall (ADM1) and Annabelle Esperanza (ADM2), and disclosed the purpose of the inspection. The ADM2 informed the LPA that the facility had five (5) residents in care and two (2) additional staff members present at the time.
LPA initiated a walk-through of the facility, accompanied by ADM2. The indoor temperature reading of 74°F on a thermostat was observed in the hallway at the time of the visit.
LPA inspected the kitchen and observed breakfast preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a magnetic locked cabinet containing knives and sharp objects. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for two (2) days and nonperishable staples for seven (7) days were observed. No expired food or stored medications were noted.
LPA inspected the dining area adjacent to the kitchen. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. Two (2) residents were observed sitting in the dining area eating breakfast.
LPA inspected the living room and observed a sofa set, chairs, recliners, a fireplace, and a television in the living room. One (1) resident was observed sitting in the living room watching TV. LPA inspected the family room and observed a covered fire place, sofa, tables, lamps, and desk in the family room.
LPA inspected a locked utility room with a washer, a dryer, furnace, air conditioner, detergents, disinfectants, and cleaning supplies.
Continued on LIC809-C
There were six (6) bedrooms, three (3) full bathrooms, and two (2) half bathrooms designated for residents' use. All (6) resident rooms were single occupancy. LPA inspected all (6) resident rooms and found them clean, well-lit, equipped with the required furniture, and had an exit door to outside deck/backyard. The bathrooms contained soap, grab bars, towels, a trash can, a shower chair, and non-slip mats/flooring. The hot water temperature at the sink faucet measured between 122.8°F to 123.6°F in all bathrooms. ADM1 adjusted the hot water setting on water heater to bring the hot water temperature below 120°F.
LPA observed three (3) hallway closets: first was linen closet with bedsheets, blankets, and towels, second closet containing incontinent supplies, and the third closet with activity supplies, board games, puzzles, arts, coloring, gloves, and paper products.
LPA inspected the fire extinguisher mounted on the wall in the hallway and found it fully charged, with the last service tag dated 08/01/2024. ADM2 tested the carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke detectors were observed in all bedrooms and common areas of the facility during the visit.
LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. No accessible bodies of water were found.
At 10:15 AM, LPA reviewed five (5) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had an Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. 2 of 5 residents (R1 and R4) didn’t have inventory for personal property/valuables. 1 of 5 residents (R1) didn’t receive Medical Assessment in the last 12 months. LPA observed that 3 of 5 staff members (S1-S3) First Aid Certificates were expired. LPA confirmed that 5 of 5 staff members were associated with the facility.
LPA observed a magnetic locked centrally stored medication cabinet located inside in the family room. Medications were organized separately for each resident. All medication bottles were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete.
LPA inspected the first aid kit and found it fully stocked. LPA reviewed Emergency Drill Logs and observed Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 06/14/2025.
Continued on LIC809-C
The following updated forms are requested to be submitted to CCLD by 08/01/2025:
LIC 500: Personnel Report
LIC 308: Designation of Facility Responsibility
Certificate of Liability Insurance
Administrator Certificate(s)
The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D.
An exit interview was conducted, and Plans of Correction were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and provided to the Administrator, Annabelle Esperanza, whose signature on this form confirms receipt of these documents.
