Routine inspection·October 27, 2025

At approximately 10:15, Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection visit. LPA was greeted by designee/caregiver Mary Ann Ordono. Administrator Charmaine Mendaros arrived shortly later. Facility is a Residential Care Facility for the Elderly that has a fire clearance approved for six non-ambulatory residents and one bedridden in rooms 1,2,4 and 5 only. Approved hospice waiver for 5 residents. LPA toured the building and grounds which was found to be clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 2/14/2025. Fire alarms and carbon monoxide detector were tested and operational. Outdoor emergency exit clear from obstruction. Water temperature measured at 116.4 degrees F at faucets accessible to residents which is within the allowable range of 105 to 120 degrees F. Disaster drills are conducted quarterly with the last drill conducted on 10/01/2025. All bedrooms were equipped with lighting, a night stand and chest of drawers. Resident bathroom lacked bath mat, grab bar was observed (Technical Advsory given). LPA observed plastic mat in shared resident room #2 to be lifted and have ripping, presenting a tripping hazard to resident (Technical Violation given). LPA observed a Fire Clearance Violation as closet in shared room 1 and 2 to be occupied for live in staff. Mattress with bedding, personal items and camera was observed inside residents closet (Deficiency Cited, see 809D) **Immediate Civil Penalty assessed in the amount of $500 due to fire clearance violation. LPA had conversation about the importance and potential dangers of having an unapproved room. Mattress was removed during inspection. Continued onto 809C... continued from 809.... LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Emergency water was observed to meet the 72 hour emergency supply, however emergency food was not observed. LPA advised admin to supply more non-perishables for emergency (Technical advisory given). Facility kitchen, refrigerators and freezers were clean, and food was stored properly with expiration dates noted. LPA observed ants to be in pantry not inside food. However, admin stated Pest Control comes monthly for treatment. LPA verified through receipts. Toxins are stored in a locked cabinet and inaccessible to residents. Sharps and knives were locked in kitchen drawer. Facility had an ample supply of linens, towels and extra hygiene products for residents. LPA reviewed 6 of 6 resident records. All required documentation was present. Physician reports were up to date. LPA reviewed 5 staff records. LPA observed CPR Certificate number that belongs to staff (S1) no longer working at facility to be the same number for S2, S3 and S4. LPA verified CPR Certification on website and verified that S1 certification belonged to S1 only. CPR certification number for S5 was not found in website. CPR for S6 was expired as of 10/03/2025 also appeared to have the same certification number as S1,S2,S3 and S4 (Deficiency Cited, see 809D). LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308-Designation of Responsibility (Retrieved during visit) Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and report read with Administrator.