Routine inspection·May 6, 2026

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit. LPA initially met with facility staff. Licensee/Administrator, Maricar Lee was contacted via telephone. At 9:35 A.M. Licensee and facility designee, Michelle Viernes, arrived at the facility. LPA explained the reason for the visit. Entrance interview was conducted. Beginning at 10:15 A.M., LPA and Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At 10:20 A.M., the smoke detectors were tested and functioned properly, as did the fire door in the hallway. At 10:22 A.M. the carbon monoxide detector was tested and functioned properly. The fire extinguishers were last serviced on 7/18/2025 and appeared fully charged. OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for resident use. LPA observed that the backyard chairs were without cushions. During today’s visit, the Administrator purchased cushions for the chairs. The attached garage was observed locked and contained the laundry area, cleaning supplies, emergency food and water supply, extra food, and storage. LPA observed a non-functional water fountain on the front yard. At the time of the visit, no water was present in the fountain. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room, family room, and dining room furniture were observed to be in good condition. LPA observed the required postings in the common area, a working phone for residents’ use and a fireplace properly screened. Continued on LIC 809-C Continued from LIC 809 KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. The water temperature in the kitchen was initially measured at 123.8 degrees Fahrenheit, and warning signs were not identified. Administrator stated that residents do not use the kitchen faucet. During today’s visit the water heater temperature was adjusted. Technical Violation BEDROOMS: LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are designated for resident use (two shared, two private) and one is designated as a staff room which was locked during the visit. During the plant tour, LPA observed that all residents’ beds were equipped with full bed rails. RESTROOMS: LPA observed 3 (three) restrooms in the facility; one is a shared restroom, one is a private restroom, and one is the staff/visitor restroom. Restrooms were clean, sanitary and in operating condition with grab bars and slip-resistant surfaces. Water temperature was measured in all resident restrooms and measured within the required range. STAFF AND RESIDENT RECORDS: Between 11:20 A.M. and 2:30 P.M. LPA reviewed records for 6 (six) residents and four (4) staff including the Administrator. During the record review, the following was observed; one resident is currently receiving hospice services, Resident #3 is bedridden, and the facility does not have and approved fire clearance for bedridden residents. LPA provided the necessary information to contact the Fire Marshal and LIC 200. MEDICATIONS: LPA reviewed medications for four (4) residents. Medications appear to be given as prescribed and documented per regulation. LPA observed that medication was being pre-popped in advanced if administration. During today’s visit LPA informed the licensee and designee that removing medication from their original packaging in advance of administration (pre-popping) is not permitted. Continued on LIC 809-C Continued from LIC 809-C Furthermore, five (5) out of six (6) residents’ Needs and service plan were outdated, with some missing the responsible representative’s signature. Additionally, three (3) out of six (6) residents has no capacity for self-care and are no longer on hospice. The Administrator stated that residents were recently discharged from hospice. The LPA informed the Administrator that the facility needs to have an approved exception with the department for each resident that requires full care and is not on hospice. Personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All personnel files were complete. The LPA obtained the following documents at the time of visit: Personnel Report (LIC500), Resident Roster (LIC9020), last emergency disaster drill, and proof of current facility’s liability insurance. Additionally, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. Emergency disaster drills are conducted quarterly, with the last fire drill conducted on 04/23/2026. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809) Administrator was informed that failure to correct the deficiencies may result in civil penalties. An immediate civil penalty of $500 for a violation of the facility’s fire clearance was issued (Refer to LIC 412M). The Licensee understands that continued violation of the facility’s fire clearance may result in additional civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.