Routine inspection·July 22, 2025

On July 22, 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 Administrator, Maylene Manalo, and disclosed the purpose of the inspection. The Administrator informed the LPA that the facility had five (5) residents in care and (2) staff members present at the time. The Licensee, Melinda Manalo joined shortly after. At 9:15 AM, the LPA initiated a walk-through of the facility, accompanied by the Administrator. LPA inspected the kitchen and found it clean, with no food preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. One (1) resident was observed eating breakfast. LPA inspected the living room and observed it clean, with all furniture in good repair. There were chairs, tables, and a television in the living room. There were five (5) bedrooms and four (4) bathrooms designated for residents' use. All five (5) resident rooms were single occupancy. LPA inspected all resident rooms and found them clean, well-lit, and equipped with the required furniture. Continued on LIC809-C At 9:38, LPA observed that non-ambulatory residents R4 and R5 in room #5 and room #2 respectively. Room #2 and #5 didn’t have an approved fire clearance for non-ambulatory residents. LPA inspected two (2) bathrooms and found them sanitary, and in good working conditions. The bathrooms contained soap, grab bars, a trash can, a shower chair, and non-slip flooring/mats. The hot water temperature at the sink faucet in both bathrooms was measured between that range of 119.4°F to 119.6°F. LPA inspected the fire extinguisher mounted on the wall in the hallway next to dining area and found it fully charged, with the last service tag dated 01/16/2025. The smoke and carbon monoxide detector located in the living room was tested 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 inspected the (2) storage closets in the hallway and observed them contained clean linens, blankets, and towels for residents’ use. LPA inspected the laundry/utility area and found it clean. A washer, a dryer, and a refrigerator, a freezer containing additional food supplies, and a pantry cabinet with non-perishable food items were observed. LPA toured the front porch and backyard areas, and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. The porch and backyard had a table, chairs, and shaded areas for resident use. Detergents, disinfectants, and cleaning supplies were observed in a locked cabinet in the backyard. No bodies of water were noted. LPA inspected (1) storage shed in the backyard and noted incontinence supplies, paper tissues, and other supplies stored. At 10:30 AM, LPA reviewed three (3) staff personnel records and five (5) resident records. The LPA observed that 3 of 5 residents were not seen by a physician in the last 12 months and 1 of 5 residents did not have the pre-admission appraisal. LPA observed that 3 of 3 staff members had LIC 508 Criminal Record Statements, LIC 503 Health Screening, and confirmed that 3 of 3 staff members were associated with the facility. At 11:50 AM, LPA observed a locked centrally stored medication cabinet next to the dining area. Medications were organized in separate bins for each resident. Centrally Stored Medication Records were reviewed and LPA observed 1 of 5 residents (R1) medication that was administered to R1 was not entered/logged in the Centrally Stored Medication Records. Continued on LIC809-C LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were not conducted quarterly, with the most recent drill completed on 06/20/2023. The following updated forms are requested to be submitted to CCLD by 07/29/2025: 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 Licensee. A copy of this report and appeal rights were discussed and left with the Licensee, Melinda Manalo, whose signature on this form confirms receipt of these documents.