Routine inspection·August 8, 2025

At 1:30 PM on 08/08/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived at the facility unannounced to conduct a required annual inspection. LPA Lindstrom was greeted by two staff members. The LPA identified herself, explained the purpose of the visit, and asked to meet with the Administrator. Staff called the Administrator, who authorized her on-duty staff with designated facility responsibility to accompany the LPA on a tour of the facility. The CARE inspection tool was used during this inspection. At the time of this inspection, the Administrator had a valid Administrator Certificate (#7026256740), which expires on 2/14/2027. Both staff on duty at the time of this visit had criminal background clearances. The facility is a four-bedroom, single-story house in a residential neighborhood. The facility is licensed to serve 6 residents. At the time of this inspection, the facility census was four, although the capacity was six. The LPA began the tour in the front yard. The front yard has bushes, trees, and rock xeriscape. The LPA entered the facility through the front door and observed that it was clean, decorated, odor-free, and full of natural light. The LPA toured the common areas including the living room, dining room, and family room. The LPA observed a resident in the living room watching television. The living room contained a couch, a rocking chair, and three chairs with footrests. A dining room table with chairs separated the living room from the kitchen. A fire extinguisher hung from the wall that was last serviced by A.R.F. Fire Extinguisher Co. on February 2025. There was an extra family room with additional seating and a television off the kitchen. The LPA toured the kitchen. The kitchen was clean and sanitary. The LPA observed a seven-day supply of non-perishable food and two-day supply of perishable food in the kitchen cabinets, pantry, and refrigerator/freezer. There were enough utensils and dishware for all residents. The trash can had a lid on it. Sharps were locked in an upper cabinet and chemicals were locked in the cabinet under the kitchen sink. The LPA observed the required postings on the wall, including the license, Administrator’s Certificate, Complaint Hotline poster, fire clearance, licensing reports, and Facility Sketch. The LPA toured the four bedrooms. The LPA observed that all the bedrooms were clean, organized, and contained the required furniture. Each bedroom contained personal objects and decorations unique to its residents. The temperature on the thermostat in the bedroom hallway was 80 degrees Fahrenheit. There was a small walk-in space off this hallway that contained extra bedding and office supplies. Staff tested the carbon monoxide/smoke detector in the hallway and the alarm sounded. The LPA inspected the locked central medication storage area, which was in a locked closet in the bedroom hallway. The LPA observed separate storage units for each resident’s medication. All medicine was in its original container with unaltered labels. The facility used a paper-based Medication Administration Record (MAR), which staff initials after assisting with each medication administration. The first aid kit stored in this closet contained all the required items. The LPA toured two full bathrooms. The bathrooms were clean and odor free. Both bathrooms contained grab bars and non-slip surfaces. The hot water temperature measured within the required range. The facility had the water heater adjusted yesterday, which the LPA confirmed with the Administrator, and staff will monitor the water temperature to ensure it stays in compliance. The LPA toured the garage. The LPA observed a washer, dryer, and an additional refrigerator/freezer with extra food in the garage. Staff used the garage to store resident supplies. The LPA toured the backyard. The backyard had a decorative border of plants along the fence line. The fence surrounding the backyard was sturdy and intact, and the walkways were free from obstruction. There was a table with a shade umbrella and chairs for residents on the back patio. There was a shed in the backyard used for storage by residents and staff. The LPA requested staff and resident records. The LPA inspected these records and found them complete. The LPA requested that updated copies of the following documents be submitted to Licensing by 5:00 PM on 87/22/2025. These documents can be emailed to LPA at ellen.lindstrom@dss.ca.gov. (1) LIC 308 Designation of Facility Responsibility (2) Copy of a current Administrator Certificate (3) LIC 500 Personnel Report (4) LIC 610 Emergency Disaster Plan (5) Proof of Liability Insurance (6) LIC 309 Administrative Organization As a result of this inspection, no deficiencies were cited. The facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6. An exit interview was conducted with staff, to whom a copy of this LIC809 report was provided. Their signature below confirms receipt of this document.