Routine inspection·August 7, 2025

08/6/2025, Licensing Program Analyst (LPA) Hansen conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. LPA was greeted by Chris Gabay(Staff) who contacted Licensee Teddy Rico that arrived shortly after. Facility is single story, 4 resident bedroom, Residential care facility for the elderly. There are currently five(5) residents in care. Facility approved/cleared for six(6) non-ambulatory, one(1) bedridden, and hospice waiver for two(2). At approximately 8:15am, LPA and staff toured the building and grounds and was joined by Licensee. 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 equipped with lighting, night stand, and drawers. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care measured 131.1 degrees F & 132.4 degrees F not within range of 105 to 120 degrees F (see LIC809D). Licensee turned water heater down. Fire extinguishers were last inspected 1/3/2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins-laundry detergent observed in laundry closet unlocked (see pics) & cleaning supplies observed in unlocked cabinet in garage (see pics), sharps observed in kitchen drawer with broken lock (see pics) and other items that could pose threat if available to residents were found to be unsecured(see LIC809D). LPA conducted spot medication count and found five out of five resident medication to not be recorded as required on the Centrally Stored Medication Record (see LIC809D). Medications for residents were pre-poured for the full day (see LIC809D). Resident prescription bottles were written on by staff (see pics & LIC9102-TA). Continued on LIC809-C Continued from LIC809 At approximately 10:00 am, LPA conducted a review of five resident records. Five out of five resident files had appropriate documentation. At approximately 11:15 am, LPA conducted review of five staff records/training. Upon a review of staff records, LPA found all staff are background cleared and associated to facility as well, have current 1st Aid & CPR certification on file. All five out of five staff have the required trainings on file. Disaster drills have been conducted quarterly with the last being on 7/12/2025. Facility has generator in garage in case of emergency. Administrator certificate for Jordan Rico #7011840740 expires on 5/19/2026. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.. 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 (if changes) LIC309- Administrative Organization LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Exit interview conducted with Licensee and a copy of this report was provided .