Routine inspection·September 23, 2025

On 9/23/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived at the facility unannounced to conduct a required 1-year annual inspection. LPA Lindstrom met with care staff provider Helen Retirado and explained the purpose of the visit. The Administrator joined the site visit at 11:00 AM. The Administrator’s certificate # is 7023863740, expiration 11/9/2026. The facility is a four-bedroom, two-bathroom house in a residential neighborhood. There were two on-duty staff and one resident at the facility at the time of the visit. Both staff have criminal background clearances. The current census is four. LPA Lindstrom toured the interior of the facility. The interior was clean, orderly, and odor-free. The required documents were hanging on the wall in the entry way. The living room and dining room contained enough furniture for all residents. The four bedrooms were occupied by single residents. Each bedroom was clean and contained the required furniture. The two bathrooms were clean, odor-free and included grab bars and non-slip flooring. The hot water in the hallway bathroom was 110 degrees Fahrenheit, within the required range. A hallway closet contained extra towels and bedding, as well as cleaning supplies and extra toiletries in a locked cabinet. The kitchen was clean and sanitary. LPA Lindstrom observed a two-day supply of perishable food and seven-day supply of non-perishable food in the kitchen cabinets and refrigerator, as well as a refrigerator in the garage. All sharps, cleaners, and toxins were in locked drawers and cabinets in the kitchen. The LPA observed multiple first aid kits that contained the required items. The fire extinguisher was located in the kitchen and was last serviced on 8/15/2025 by Jorgensen Co. The smoke and carbon monoxide detectors were in working order. The backyard was manicured, had an intact perimeter fence, and included a shaded area with seating. The walkways on the grounds were free of obstruction. (continued on LIC809-C) LPA Lindstrom inspected facility records, including two staff records and four resident records. The staff and resident records were complete. LPA Lindstrom did an audit of two residena's cash resources managed by the facility and verified its accuracy. LPA Lindstrom observed resident medication stored in a locked cabinet. The paper-based medication administration records and centrally stored medication and destruction records were complete and up to date. The facility conducts disaster drills monthly and maintains a log of each drill. The Administrator reviews and updates the infection control plan and emergency disaster drill on a yearly basis. As a result of this inspection, no deficiencies were cited. The facility was in compliance with the California Code of Regulations (CCR), Title 22, Division 6 An exit interview was conducted with the Administrator, to whom a copy of this LIC 809 report was provided. Their signature below confirms receipt of this document.