Routine inspection·July 29, 2025

07/29/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 5 residents in care. Facility approved/cleared for 6 ambulatory, of which 6 may be non-ambulatory and a hospice waiver for 3. LPA met with Evelyn Serrano, Licensee and Jully Cartel, Administrator. Both Licensee and Administrator gave permission for Caregiver to sign report. LPA and caregiver toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 126.8 and 123.0 falling out of regulation range of 105 to 120 degrees F (Deficiency Cited). Fire extinguishers were charged and last purchased 09/05/2024. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose threat if available to residents were located under the kitchen sink and found to be secured. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted a review of 5 resident records. All records had the required documentation. However, LPA observed 2 of the 5 residents to not have an updated medical assessment (Technical Violation). LPA spoke with caregiver about ensuring residents receive an annual visit with a medical professional once every 12 months. Continued on LIC809-C LPA conducted review of 4 staff records/training. Upon a review of staff records, LPA found 3 out of 4 staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. LPA found 1 out of 4 staff to have missing 4 hours of dementia training. LPA spoke with staff about ensuring they complete the 8 hours of required dementia care training. 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. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 08/29/2025: LIC308- Designation of Responsibility Updated Liability Insurance Register of Facility Clients/Residents Exit interview conducted with Caregiver and a copy of this report was provided.