Routine inspection·July 1, 2025

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 7/1/25 at approximately 2:20pm, and met with Licensee/Administrator Estelita Guzman. LPA observed the Administrator, and four (4) caregivers working at the time of arrival. There are currently seven (7) residents in care. Fire clearance is approved for nine (9) non-ambulatory, of which two (2) may be bedridden. Facility has nine (9) private resident rooms. 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. The facility has an emergency disaster plan as required. LPA reviewed five (5) resident files; Resident files were complete. LPA reviewed five (5) staff files. All staff have first aid and CPR certification. LPA reviewed staff training. LPA toured the facility with the Administrator. Facility was clean and orderly during the inspection. Hot water was measured at 109.8 degrees Fahrenheit. All exits had auditory alarms. All exits were clear of obstruction. All facility walkways and ramps were free and clear of obstruction. All smoke alarms and carbon monoxide detectors were working properly during the inspection.Facility had sufficient lighting in resident rooms, bathrooms, hallways, and all common areas for residents in care. Bathrooms had grab bars, and mats in all showers for resident use. Continued on LIC809C... Continued from LIC809, dated 7/1/25. The backyard deck has patio furnishings and shade umbrellas for resident use. There is a front yard ramp and two backyard ramps for resident use, and to use in the event of an emergency. Sufficient food supply was observed by the LPA. Sufficient supply of hygiene products, paper products, linens, cleaners/disinfectants, and personal protective equipment (PPE). Facility had emergency supplies to meet the "72 hour Shelter In Place requirements". LPA is requesting the following documents be updated and submitted by 8/1/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate Emergency Disaster Plan- Update as required/if changes-submit copy if any updates. Infection Control Plan- Update as required/if changes-submit copy if any updates. The following deficiencies were observed during the inspection: LPA observed refrigerated medication in a small, unlocked refrigerator in the kitchen; LPA observed that the two medication bottles were left unlocked and accessible to residents in care . This deficiency will be cited, 87465(h)(2 Incidental Medical and Dental, see LIC809D. Per LPA record reviews, Licensee lacked proof of conducting required quarterly drills per health & Safety Code. This deficiency will be cited, HSC1569.695(a)(2) Quarterly Emergency Disaster Drills, see LIC809D. Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency (s) and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights were provided. Exit interview conducted with the Administrator, Estelita Guzman.