Routine inspection·October 3, 2025

On 10/03/2025 at approximately 09:30AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to conduct 1-Year Required visit of this licensed Residential Care Facility for The Elderly (RCFE). LPA was greeted by Staff Member, Cynthia Florada. Administrator, Edward Gadia arrived during visit at approximately at 10AM. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents, of which 1 may be bedridden. The facility currently approved for capacity of 6 residents. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 2 residents in care and 2 staff members on-site. Facility is a 1 story building with 6 Resident bedrooms, 2 staff bedrooms, 2 bathrooms, and common spaces. At approximately 10AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:45AM, LPA and Licensee toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. However, LPA discovered backyard Fire Emergency exit door lock was not working properly. Administrator agrees to repair the exit door lock and submit the proof of correction to the CCL (Technical Violation Given). All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Staff were in the process of cleaning up kitchen at the time of this inspection. Toxins are stored in a locked housekeeping closet. Water temperature measured 111.6 degrees F and 112.8 degrees F which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Continued on LIC809-C page... Continued from LIC809 page... Fire Extinguishers found to be last charged on 07/30/2025 at the time of visit. Carbon Monoxide and smoke detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in a cabinet next to the dining room. During the centrally stored medication record review LPA discovered some of the medications were not recorded on the facility log. Administrator agrees to update centrally stored medication log and submit CCL (See LIC809-D page). At approximately 11:35PM, LPA reviewed 2 resident records and found 2 of 2 residents have current care plans, signed admission agreements, and physician's report on file. 1 out of 2 residents did not have TB test result on file. Administrator agreed to share TB test results for R1 with the Community Care Licensing (Technical advice given). At approximately 12:05PM, LPA reviewed 2 staff records. 2 of 2 records did contain documentation of completed training records as required. Evidence of current first aid and CPR training were current. LPA was presented with proof of current CPR & 1 st Aid certification. Administrator Certificate is for Edward Gadia #7006929740 expires 11/20/2026. LPA reviewed the facility emergency disaster plan. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 06/10/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by due date of 10/15/2025: LIC 308 Designation of Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy/Proof of Updated Certificate of Liability Insurance 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. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.