Routine inspection·August 22, 2025

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year Visit and met with staff Elizabeth Gonzalez. 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 observed the first aid kit and found it to be complete. LPA toured two out of two resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks were 112 F and 116 F. LPA tested the smoke detectors in the hallways and in six out of six resident bedrooms. Each smoke detector functioned properly when tested. LPA tested one out of one carbon monoxide detector and it functioned properly when tested. LPA toured six out of six resident bedrooms and found each bedroom to have working lights. All the occupied bedrooms had available bedding and clothing storage areas. During visit, LPA observed that a sliding glass door did not completely close and lock and two staff were needed to open and close the sliding door. LPA observed a hole about 3 inches in diameter in one of the resident bedrooms. LPA toured the outside area and found the outdoor exits were clear of obstructions. The Emergency Disaster Drill Log indicates the last disaster drill was conducted on 06/06/2025. See LIC809-C page for more information. Page 1 of 2. LPA Marrufo reviewed three out of three resident records, including Centrally Stored Medication and Destruction Records. Resident R1 had the wrong prescription number for one medication. LPA reviewed 5 staff records. Staff S1 was missing a Health Screening Form. S2 was missing a current first aid certification. Advisory Notes were issued. See LIC9102 forms for more information. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. LPA Marrufo requests that the following records be updated and sent to LPA Marrufo within 5 business days: LIC500 Personnel Report Current Liability Insurance Record Emergency Disaster Plan This report was reviewed with staff Elizabeth Gonzalez and a copy of the report and appeal rights were provided.