Routine inspection·July 24, 2025

Licensing Program Analyst (LPA) Cuadra arrived unnanounced to conduct a Required Annual Inspection and met with Charito Santos (Administrative Assistant), Jasmine Aquino (back up Administrator) arrived later. There are outstanding annual fees in the amount of $1238. Required postings were observed. LPA/back up Administrator toured the facility at 9:00am and made the following observations: Facility was a comfortable temperature with thermostat reading at 73 degrees F. Passageways were free from obstructions. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cleaning supplies were also observed under the kitchen sink. Knives are located in a locked drawer in the kitchen. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked in a medication cart located in the office. Fire extinguisher was last inspected June 2025. Smoke and Carbon Monoxide detectors were tested during inspection and they were found operational. The last fire inspection conducted by Santa Rosa Fire Equipment Service was conducted on 5/19/25. Exit doors have auditory alert system that were functional at time of visit. Cash resources and records were reviewed. Emergency Disaster Drill has not been conducted within the last quarter (7/24/24). During last annual LPA discussed with Licensee the requirement of resident rooms needed a chair per resident per regulation, today there are some rooms needing the chair (technical violation issued). LPA/Back up administrator observed garbage cans needed to have a lid/cover in resident's bedrooms, bathrooms and living room (technical violation issued). Medications and medication records were reviewed. -At approximately 9:10am LPA/Back up administrator measured water temperature in resident's bathrooms measured at 121.8 & 121.6 degrees F, which are not within allowable range of 105-120 degrees F. Continued on LIC809C... Continued from LIC809... -At approximately 9:20am LPA/back up Administrator observed electric face plates in the dining room exposing cables, ceiling holes in resident's rooms are exposing cables, walls in room #6 needs to be painted, bathroom #6 ceiling has mold, debris of a bed in the backyard, corner walls at wing B needs to be repaired, wall in room #15 needs to be painted, shared bathroom #27 in wing B mirror needs to be replaced it has mold, hallway restroom in wing B floor needs to be repaired, there were insects: ants, spiders and spider webs inside of resident's bedrooms. Two window screens needs to be repaired or replaced. File review was initiated at 10:00 am. Nine resident and four staff files were reviewed. One out of nine residents (R1) medical assessment did not have a diagnosis (technical violation issued), nine out of nine residents (R1, R2, R3, R4, R5, R6, R7, R8 & R9) doesn't have current appraisal/needs and services plans on file. Four out of four staff (S1, S2, S3 & S4) do not have 1st aid/CPR certificates on file. According to Administrative Assistance, all staff took certification together, but they don't have the certificates as of today yet. All staff have required 20 hours of additional training. Administrator Certificate for Nicanor Aquino 7002914740 expires October 7, 2025. Today, LPA learned that back up Administrator will be submitting their documentation required to take over the administrator responsibility for this facility and the Licensee's other facility, Mc Hugh Care Home 490108000 in which Tiffany Dizon is the identified Administrator. LPA is providing required documentation to change administrator as follow by 7/31/2025: LIC 308 Designation of Facility responsibility (designation of who is the administrator), LIC 500 Personnel Report (stating the numbers of hours when Administrator will be present at the facility), LIC 501 Personnel Record, Copy of Personal ID and copy of current administrator’s certificate. Licensee also will submit updates of the following Liability Insurance and Surety bond. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. The Department will be reviewing the information obtained to determine if further actions are needed. Exit interview was conducted with Administrative Assistant and a copy of this report was given.