Routine inspection·October 17, 2025

Licensing Program Analyst (LPA) Maria (Mita) Partoza a conducted an unannounced required 1 year inspection visit and met with administrator (LIC/ADM) Thelma Llanes. LPA stated the purpose of the visit. The facility is licensed to serve adults 60 and over, approved for 6 non-ambulatory and waiver for 2 hospice and 1 bedridden. LPA observed 4 residents present at the facility that have neurocognitive disorder, Staff 1 was attending to the needs of the resident. LPA toured the facility inside and outside with ADM including but not limited to the kitchen, bathroom, dining room, living room, 4 residents rooms, garage, staff room, backyard and exterior walkways. LPA observed that the facility sun room is currently under construction for repairs. The ramp was sturdy and no planks missing, not obstructed by any debris. The outdoor covered patio area has exercise equipment and construction equipment that are no longer in use and not accessible for resident's enjoyment. The kitchen, dining room, living room and entry way is kept maintained, sanitary and organized. The bathroom/s are equipped with grab bars, non-skid mats. Resident's room have sufficient storage. Knives and sharps were locked and not accessible to residents. Medications are in a locked cabinet. LPA observed 2 days of perishable food,however the 7 day non-perishable food is not sufficient to sustain 4 resident and 2 staff in the event of an emergency. ADM scheduled the food purchasing for 10/18/25. see lic 809C Page 1 of 2 The temperature inside the home was at 73 degrees Fahrenheit. The water temperature in the bathroom measured between 105.8 degree Fahrenheit and kitchen water temperature is measured at 107.8 degree F. LPA observed 3 refrigerator/freezer combination. The refrigerator temperature is 32 degree F and freezer is at 0 degree F. The facility is equipped with 4 camera located in the kitchen, dining, living area and hallways. No camera was observed inside the resident rooms. LPA observed smoke and carbon monoxide alarm. The fire alarm wired to detect smoke or fire. ADM stated that the camera are not recording any audio. LPA reviewed 4 resident record, 4 out of 4 resident record is missing personal rights, 2 out of 4 has no TB on record, 2 out of 4 are missing medical assessment, 4 out of 4 are missing pre-admission appraisal forms, 1 out of 4 is missing the Centrally Stored Medication and Destruction Record (CSMDR), 4 out of 4 is missing the personal valuable list. 2 Out of 4 resident does not have an updated appraisal needs and services plan. 4 Out of 4 does not have the emergency identification sheet. 4 Out of 4 does not have the consent form to release medical information in the event of an emergency. LPA reviewed the facility file, ADM was not able to provide proof of the emergency preparedness and disaster training drill. 1 Out of 2 staff record was reviewed. 1 out of 2 does not have a 1st Aid/CPR training 1 out of 2 does not have on boarding training, 2 out of 2 have no medical training that are updated. Last training was administered on June 2019. Due to time constraint the annual inspection will be continued and citations will be issued based on today's inspection observation and document reviews based on California Code of Regulations (CCR) Title 22 for staff training, personnel requirement, health and safety, building maintenance, food service, resident records and facility record. LPA suggested for administrator to reach out to Technical Support Program offered by the Department. An exit interview is conducted with administrator Thelma Llanes and a copy of the report was provided. end of report page 2 of 2