Routine inspection·January 29, 2026

At approximately 9:45 PM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by facility Staff Imelda Mallari who has Designation of Facility Responsibility (RP). RP called Administrator who arrived at approximately 9:55 AM to assist with today's inspection Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, and a Hospice waiver for three (3) and facility currently cares for two(2) hospice residents. Licensee recently modified home and applied for one (1) converted non-ambulatory bedrooms which the fire department granted on 08/13/2025. Facility is now approved for 6 non-ambulatory residents. At approximately 10:15 AM, LPA initiated a tour of the facility with House Manager and observed the following: Facility is a one story home, was a comfortable temperature, bright and facility was without odors. Passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Facility also has an emergency generator available. Continued on LIC809-C... Continued for LIC809 LPA observed a number of unzipped and undated meat portions in the refrigerator, as well as, at least one instance of condiment sauce that required refrigeration after opening. A type B citatio n is being cited for violation of CCR 87555(b)(9) There is a shaded seating area in the backyard with outdoor space for activities. LPA inspected two locked sheds in the backyard which contained care equipment, holiday decorations, tools, and chemicals. LPA observed residents watching TV or reading in the common area and in their bedrooms. LPA observed games available to residents. Facility now has a dedicated internet access device and internet service available to residents in care and the telephone was tested an operational during inspection. At approximately 11:30 AM, LPA conducted file review and observed the following; Four (4) of (4) staff files had all required documentation including medical exams, criminal clearance and TB testing. At approximately 12:15 PM LPA observed the following: Six(6) of 6 residents files and all had required documentation. LPA observed resident (R1) sitting up comfortably in a wheelchair in the living room and dinning area, but is designated as "Bedridden" on their recent Physicians Report. A type B citation for violation of fire clearance CCR87606(c) with licensee asked to ensure R1 has a re-evaluation by their physician by Plan of Correction date and to notify LPA if they cannot secure that appointment. Licensee states that the facility and residents' family members coordinate residents' medical and dental appointments and transportation to and from visits. Medications and medication records were inspected and observed maintained in compliance with regulation. Facility does not handle P&I money LPA obtained the follow documents for the facility file today including: LIC500 Personnel Report LIC9020 Register of Facility Residents Updated Liability Insurance Two (2) LIC 308 Designation of Facility Responsibility Reviewed LIC610D Emergency Disaster Plan Continued on LIC809C Continued from LIC809C Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Edward Gadia and Appeal rights were given