Routine inspection·October 14, 2025

Licensing Program Analyst (LPA) Alviso conducted a Required - 1 Year inspection and met with live-in caregiver Melanie Taningco. A second caregiver, Brian, was also observed to be working during the inspection. Administrator Josephine Blancaflor was contacted, and arrived within the hour to meet with the LPA. There were six (6) residents in care during the LPA's inspection. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden approval (room #1 only). Fire extinguishers (2) were serviced and tagged as required. Facility has a hard wired smoke alarm system, which also has carbon monoxide check. The alarm system was put into test mode to check that it was working properly during the inspection. All exits were free and clear of obstructions. The backyard self latching fire exit gate opened freely, as required. Emergency disaster drills are being conducted quarterly as required; Last drill was conducted with facility staff on 9/3/25. The LPA reviewed six (6) resident files, resident medication records, and medication storage, including refrigerated medications. All files had required documentation. The LPA reviewed five (5) staff files. All staff had criminal record clearance as required. All staff had required first aid certification, and CPR certification, as required. All staff annual training was reviewed during the inspection. Continued on LIC809C... LPA toured the facility with caregiver Brian and the Administrator. Hot water was 107.4 degrees Fahrenheit, which is within regulation. Facility was clean and orderly. Food supply was sufficient with both perishable and non-perishable foods. Resident rooms, bathrooms, hallways, and common areas had sufficient lighting for residents in care. The facility was at a comfortable temperature during the inspection. There was a sufficient supply of hygiene products, linens, cleaners/disinfectants, personal protective equipment (PPE), and paper products. All bathrooms had grab bars, and shower had non-slip mat for residents' use. All disinfectants/cleaners were locked and inaccessible to residents in care. All medications were locked and inaccessible to residents in care. LPA observed all utilities to be working appropriately, and available for use as required for facility operations. LPA observed the following deficiency: Per LPA's record reviews, R5 is diabetic, and needs insulin injections, per medical assessment dated 8/12/25. R5 has a one touch blood- glucose meter on that reads blood glucose levels. Per interview with staff S1, R5 does own insulin injection. Per medical assessment, R5 is not able to provide own injections or handle own medications; There is no Dr's Order that R5 is able to provide own injections or self inject the insulin KwikPen as needed. This deficiency will be cited, 87629(a) Injections - The licensee shall be permitted to accept or retain a resident who requires intramuscular, subcutaneous, or intradermal injections if the injections are administered by the resident or by an appropriately skilled professional, see LIC809D. Deficiencies 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. Appeal rights provided to the Administrator. Exit interview conducted with Licensee/Administrator Josephine Blancaflor.