Routine inspection·December 14, 2023

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit and met with Administrator (ADM) Jean Jose and Licensee (LCN) Gano Fici. LPA reviewed 5 residents files and 5 staff files.LPA toured the facility inside out with ADM. Licensee, Personal Rights posters and Administrator Certificate were observed at the main entrance. Living room, family room, dining room, kitchen, 6 resident bedroom rooms, 3 restrooms, and laundry room were inspected. 2 staff and 6 residents were observed in the facility. Two day perishable food supplies and Seven day nonperishable food supplies were observed sufficient. Room temperature was observed at 71 degree F. Hot water temperature was observed at 115 degree F. Refrigerator temperature was observed at 40 degree F. Freezer temperature was observed at 0 degree F. All of the bedrooms were observed with window screens and in good repair. Fire extinguisher was serviced on 11/28/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors were tested by ADM, and were working fine. Medications closet was observed locked. Knives closet and detergent closet were observed locked. One of the bathroom was observed without nonskid pad. The bedroom with resident using Oxygen administration was observed with the warning sign. First aid box was observed in the facility. Night lights were observed at the hallway. LPA toured the backyard with ADM. There were no obstacles blocked the exit. The facility last fire and emergency drill was conducted on 10/7/2023. Continue on LIC9099-C. Page 1 of 3. During LPAs visit, LPA met with ADM Jean Jose and Licensee, Gano Fici. While conducting inspection with ADM, R1 asked ADM why he/she couldn’t go back to his/her bedroom wherein it was locked. ADM stated that the bedroom (garage converted into an office) has inverted doorknob. ADM stated that when LPA arrived at the facility, it was open. LPA asked to ADM and L1 to unlocked doorknob wherein both stated they did not have the key. Subsequently, L1 unlocked the door. LPA ask the ADM to unlocked the door. L1 stated his/her spouse has the key, L2. L2 was not in the facility. Licensee was aware that the converted garage has been denied as a living quarter for staff or any individuals and can only be used as an office space by the Milpitas Fire Department. On April 2, 2013 the facility was cited for over capacity. On February 16, 2016 Licensee was informed that the garage could only be used an office and not a living space for residents or staff. In addition, during a Non-Compliance Conference Meeting on 12/2/2015 wherein the garage cannot be used as a living space. Licensee and Administrator must submit a plan of action to relocate R1 and R2 by end of business, 12/15/23. LPAs interviewed ADM Jose Jean and staff (S1) who admitted that residents (R1 and R2) are sleeping in the office (converted garage) on 12/5/2023. During LPAs interview with Mr. Fici (licensee). Mr. Fici was asked if he admitted 2 residents beyond the allowed licensed capacity. Mr. Fici stated that there were no residents occupying the converted garage rather it is a storage for unused beds. LPAs inspected the converted garage wherein R1 and R2’s beds and personal belongings for R1 and R2, confirmed by ADM. Prior to 4:52 PM, LPA Chang called Licensing Program Manager (LPM) Manzano to consult about over capacity. LPM requested to speak with the ADM. While LPM was on the phone with ADM Jean Jose about the over capacity, during the phone conversation, LPM overheard Mr. Fici stating, “tell we have 6.” ADM stated Mr. Fici said, ‘we have 6.’ Subsequently, ADM told the truth to LPA and LPM that on 12/5, Mr. Fici, has admitted new two elderly residents (R1 and R2) in the converted garage. During interview with ADM and S1, LPAs also found out that ADM and S1 are sleeping in the couch and at the back of the house near the laundry area, based on their admissions. The facility does not have staff bedroom, therefore, the facility must have a awake night staff. On 2/16/2016, The facility licensee and ADM stated the noc shift staff are not allowed to sleep. LPA may issue more citations if more deficiencies were found. Continue on LIC809-C. Page 2 of 3. At approximately 7:30pm, Licensee L2 arrived at the facility. L2 was interviewed. L2 denied the facility admitted additional two residents beyond the approved license capacity. L2 stated the converted garage (office) is a storage room. Exit interview was conducted with ADM and LCN. LIC809-D and Appeal Rights were attached. The report was provided to ADM and LCN for signature. A copy of the report was provided to ADM and LCN. The annual required inspection will be continued at a later date. Page 3 of 3.