Routine inspection·March 9, 2026

At approximately 12:45 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and met with Designee Anabel Tuason. 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 three (3), with zero (0) Hospice residents currently in care, and is approved for all non-ambulatory residents, of which two (2) may be bedridden. 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 1:15 PM, 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. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 105.2 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. There is a shaded seating area in the backyard with outdoor space for activities. Continued LIC809C... Continued from LIC809... LPA was informed that facility will be undergoing renovations to replace flooring, doors, windows, and to make bathroom more accessible. LPA informed designee that a plan detailing exact construction and how residents safety/personal rights will be ensured shall be submitted to Community Care Licensing (CCL) as soon as possible. At approximately 2:10 PM LPA and Designee conducted a spot check of medication and medication records. Medication is centrally stored and locked. Ephraim Pajarillo Administrator Certificate 7030241740 expires 2/20/2027. LPA unable to complete Annual Visit. Annual Continuation Visit to be conducted at a later date. LPA will review items including resident files, staff files, disaster drills/emergency protocols, required postings, fire safety, and activities. Updated copies of the following documents shall be submitted to CCL by 4/6/2026 : Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Designee, whose signature on form confirms receipt.