Routine inspection·June 26, 2025

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Designated Administrator Elvira Rodriguez. Administrator (ADM) Mark Vasquez was in a meeting during inspection. LPA stated the purpose of the visit. Designated Administrator states the facility has 6 residents. LPA toured the interior and exterior of the facility with Designated Administrator to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature log for 6/26/2025 with refrigerator temperature documented at 35 degrees F and freezer at 0 degrees F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by maintenance. Fire extinguishers were last serviced on 5/12/2025. The facility emergency drill log was reviewed. The facility's last drill was on 6/12/2025. Drills are being conducted monthly. Page 1 of 2 LPA toured 4 resident bedrooms. All 4 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA toured 2 bathrooms. All 2 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. At 1:13PM LPA measured water temperature in 2 resident bathrooms with a range from 149.7 degrees F to 150.6 degrees F. Designated Administrator had maintenance staff come to adjust water temperature. At 2:00PM LPA measured water temperature at 150 degrees F. LPA issued a Technical Assistance. LPA reviewed 4 resident records. LPA reviewed 4 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA observed Resident R1 and R2 were not given the correct medication dosage on 6/24/2025. Designated Administrator stated R1 and R2 physicians were informed and no adverse reactions were observed for R1 and R2. LPAs reviewed 4 staff records. No deficiencies were cited during today's visit per California Code of Regulations Title 22. A Technical Assistance was issued. See LIC9102 for more information. An exit interview was conducted with Designated Administrator Elvira Rodriguez and a signed copy of this report was provided. Page 2 of 2