Routine inspection·August 13, 2025

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 8/13/25 at approximately 10:25am, and met with Licensee Rose Aquino, and Administrator Rafael Aquino. There currently are five (5) residents in care. LPA observed two caregivers on duty upon admission into the facility. Fire clearance approval is for six (6) non-ambulatory residents, there is no bedridden approval. Facility has an approved hospice waiver for one (1). Facility has an approved dementia plan of operation. Facility has a required infection control plan. Facility has an emergency disaster plan as required. LPA reviewed five (5) resident files. Files were complete. LPA reviewed four (4) staff files. All staff had required criminal record clearance. Staff had required first aid certification and CPR certification, per file reviews. LPA toured the facility with Administrator Rafael. Facility was observed to clean and orderly. All postings were visible to all entering facility. Hot water was measured at 113. degrees Fahrenheit. All bathrooms had grab bars, and shower mats/non-slip flooring for resident use. Fire extinguisher was serviced and tagged as required. All exits were clear and free from obstruction. The bathrooms, resident rooms, hallways, and all common areas had sufficient lighting for residents' in care, and for use by residents. Facility had sufficient furnishings for resident use.Backyard was free and clear of any hazards, and backyard fire exit path was clear and free of obstruction. The backyard had patio furniture for residents' use. Exit doors had auditory alarms. Food supply was sufficient. Facility had sufficient supply of cleaners, paper products, linens. and personal protective equipment (PPE). Continued on LIC809C.. Continued from LIC809, dated 8/13/2025... LPA requested the following documents be updated and submitted to CCL by 9/13/2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 (9 pages) - Emergency Disaster Plan- if updates, submit copy to CCL Infection Control Plan- if updates, submit copy to CCL Copy of LIC400 Handling of Client Cash Resources- complete & submit (all facilities complete form) Copy of Surety Bond- if handling cash Copy of Current Liability Insurance Roster of residents Copy of current Administrator Certificate Deficiencies observed by the LPA during inspection. Staff S3 and S4, who are direct caregivers, lacked proof of required annual training, per file reviews. This deficiency will be cited, HSC 1569.625(b)(2) Staff training; legislative findings; contents - In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training, see LIC809D. Staff S3 and S4, who assist residents with medications, lacked proof of required medication training, per file reviews. This deficiency will be cited, HSC 1569.69 (b) -Employees assisting residents with self-administration of medication; training requirements. Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator Rafael Aquino. Appeal Rights provided to the Administrator.