Routine inspection·April 29, 2026

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by licensee, Martha Marimbi. Facility currently has five (5) residents in care three (3) of which are currently on hospice. At approximately 9:30am LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled with opened dates present. Locked cabinet in laundry room contains disinfectants and cleaning supplies. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 111.1 degrees F in the back main bathroom, 115.4 degrees F in room #1, and 111.8 degrees F in room #2 all of which are within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 2/19/26. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 3/27/26. Facility has a backup generator for use during a power outage. Martha Marimbi Administrator Certificate 7018478740 expires 3/21/27 All fees are current as of this time. Annual fee due 5/6/26. Fee notification given to Admin along with PIN for online payment. LPA and Licensee discussed Emergency Disaster Plan. Licensee confirmed no updates needed. Continued on 809C... Continued from 809... At approximately 11:00am LPA conducted a review of five (5) out of five (5) resident files. LPA reviewed hospice care plans for three (3) out of three (3) residents currently on hospice. LPA discussed with licensee PRN authorization letter for residents acts as more detailed description of resident ability as observed or required by doctor. LPA discussed with licensee Admission Agreement addendums for those residents that were residents before licensee change. LPA discussed using LIC625 in addition to or instead of LIC603A when documenting the appraisal of residents' care needs after the Pre-Placement appraisal. At approximately 12:30pm LPA conducted review of five (5) staff files. All staff have current 1st Aid/CPR certification. Staff (S1, S3, and S4) all had start dates in 2026 and therefore are required to have 40 hours of training to be completed. S1 has completed 26 hours, S3 has completed 21 hours, and S4 has completed 35 hours. S5's start date was in 2022 and has completed 12 hours of the required 20 hours ( deficiency cited, see 809D ). LPA discussed medication training requirement for all those staff administering medications. LPA discussed Health and Safety Code 1569.69 which requires facilities with 15 or fewer residents need ten (10) hours of initial medication training. LPA discussed medication regulation and requirements for shadowing. At approximately 1:45pm LPA and Licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked closet. LPA discussed with licensee PRN MAR requirements and that all PRNs must be listed on the Centrally Stored Medication Log (CSML) .. 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 Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with licensee and a copy of this report was given.