Routine inspection·August 11, 2025

At approximately 10:00 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Alex Ordonez, Designee. Administrator was called and was unable to attend, Alex Ordonez is designated to sign and receive report. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), and is approved for all non-ambulatory residents. At approximately 10:25, LPA initiated a tour of the facility with Designee and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguisher was observed charged and last inspected 3/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 118.5 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, 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 locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. Outdoor patio is fully covered, has a full table for residents use, and has multiple other seats available. During visit LPA observed residents making frequent use of the patio and seating area. Facility has an internet access device and internet available to clients in care, and the phone was tested no deficiency cited. Continued LIC809C... Continued from LIC809... Facility could not show evidence of emergency drills conducted in 2025 and staff confirmed no drills had been conducted ( deficiency c ited ). LPA observed facility's infection control plan and emergency disaster plan no deficiency cited. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 10:50 AM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 11:10 AM LPA conducted review of two (2) staff records. Two (2) of two (2) staff were missing 20 hours required yearly training ( def iciency cited ) . At approximately 11:40 AM LPA and Designee conducted a spot check of medication and medication records. Medication is centrally stored and locked. Rustom Neil Lomboy Administrator Certificate 7012119740 expires 6/6/26. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL by 9/10/2025: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC809D. Exit interview conducted with Designee, whose signature on form confirms receipt.