Routine inspection (multi-day)·September 3, 2025

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced Case Management - Annual Continuation Visit and met with Administrator (ADM) Marsha Belleza. This annual inspection is a continuation of the annual visit that was conducted on 8/28/2025. LPA stated the purpose of the visit. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. The facility emergency drill log was reviewed. The facility is not conducting emergency drills for 2025. A deficiency is being issued, see LIC809-D for more information. LPA toured 4 resident bathrooms and measured water temperatures. 3 out of 4 bathrooms water temperatures were not within range, temperatures ranged from 103.8 F to 122.5 F. A Technical Violation is being issued, see LIC9102 for more information. During review of 3 resident records (R1 to R3), LPA observed 1 out of 3 records did not contain a medical assessment. R1's record did not contain a medical assessment. ADM states she is aware R1 does not have a medical assessment on file. A deficiency is being issued, see LIC809-D for more information. Page 1 of 2 During review of 9 staff records, LPA observed all 9 staff records did not contain training and first aid training. A deficiency is being issued, see LIC809-D for more information. LPA also observed S8 and S9's staff record was missing documentation. Upon further review of staff through the facility Guardian roster, S8 and S9 were not associated to the facility, but had obtained fingerprint background clearance. ADM states she is aware S8 and S9 have not been associated and had difficult accessing the facility Guardian account. ADM states S8 has worked at the facility since 1/7/2025 and S9 has worked at the facility since 8/24/2024. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for S8 working in the facility without association. Another civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for S9 working in the facility without association. See LIC421BG. LPA provided ADM with a pamphlet for Community Care Licensing Division (CCLD) Technical Support Program (TSP). An exit interview was conducted with Administrator (ADM) Marsha Belleza and signed copy of this report was provided. Appeal rights were also provided during visit. Page 2 of 2 END OF REPORT.