Routine inspection·December 15, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 11:15 AM. LPA met with facility staff who contacted the facility Administrator Tina Marie Martinez and Licensee Representative George Yazbek. The Licensee Representative arrived to the facility at 11:22 AM and the Administrator arrived to the facility at 11:25 AM. Entrance interview was conducted and the reason for the visit was explained. Beginning at 11:23 AM the LPA, along with the Licensee Representative and later the facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS : This includes the living rooms, hallway, and dining area. LPA observed the living rooms to be clean and properly furnished at the time of the visit. The living rooms contained activities for resident use including a television. The living rooms contained an appropriately screened fireplace, locked cabinets, and drawers which contained resident medications and resident, staff, and facility files. LPA observed the living rooms to contain a complete first aid kit and the facility’s telephone. The hallway was observed to be clean and free from any obstructions. The hallway contained closets that contained storage for linens and care supplies. The dining area was observed to be equipped with adequate seating for resident use. The common areas contained all required postings. The facility’s fire and carbon monoxide alarms were tested between 12:35 PM and 12:37 PM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. Continued on LIC 809C. COMMON AREAS CONT: LPA observed an unsecured bottle of Mucus Relief medication stored in a hallway drawer. LPA informed the Administrator who immediately secured the medication. BEDROOMS : There are five (5) bedrooms in the facility; two (2) are dual occupancy resident rooms, two (2) are single occupancy resident rooms, and one (1) is a staff room. LPA, the Licensee Representative, and the facility Administrator toured all five (5) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #1 contained a direct exit to the outdoors of the facility that was observed to be blocked by a chair. LPA informed the Licensee Representative who removed the obstruction at the time of the visit. LPA observed Resident #1 (R1)’s bed to contain full bed rails. LPA observed the screen door of room #1 to contain two (2) small tears in the screening material. LPA informed the Licensee Representative who performed repairs to the material at the time of the visit. KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured under-sink cabinet to contain cleaning chemicals. LPA observed secured drawers to contain knives and other sharp objects. LPA observed the kitchen to contain a wall mounted fire extinguisher to be fully charged and purchased on 02/14/2025. BATHROOMS : There are two (2) bathrooms at the facility. One is designated as a shared/common resident bathroom and one (1) is a private resident bathroom. Both resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 116.4 and 118.0 degrees Fahrenheit, which is in compliance with regulation. Both bathrooms contained secured storage which contained grooming supplies and cleaning supplies. GARAGE: The garage was observed to be locked and inaccessible to clients in care. LPA observed the garage to contain the facility’s washer and dryer, extra care supplies, sufficient emergency water supplies, an extra refrigerator/freezer, and locked cabinets which contained cleaning supplies and laundry supplies. Additionally, the garage was observed to contain a locked staff break room. Continued on LIC 809C. OUTDOOR SPACE: The facility has two (2) emergency exit gates located on either side of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the outdoors of the facility to contain a locked storage shed which contained gardening supplies and extra care supplies. LPA observed a camera located at the entrance of the facility. RECORD REVIEW: Record review began at 12:25 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. LPA observed staff trainings to be missing the name of the instructor who performed the training and the number of hours per training subject. Additionally, LPA observed one (1) staff file to be missing the twenty (20) hours of required annual training. LPA informed the Administrator of the missing trainings and the Administrator agreed to conduct trainings with staff members on the topics required by regulations. Six (6) resident files were reviewed. LPA observed R1’s bed to contain full bed rails. During file review LPA observed that R1 was not enrolled with hospice care. LPA informed the Licensee Representative that bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. The Licensee Representative expressed understanding and removed the full length bed rails from R1’s bed at the time of the visit. LPA observed Resident #2 (R2)’s Appraisal Needs and Services plan to be dated 10/03/2024. LPA informed the Administrator that resident appraisals shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first. The Administrator expressed understanding and completed an updated Appraisal Needs and Services plan for R2 at the time of the visit. MEDICATION REVIEW: Medication review began at 02:05 PM. Medications for three (3) of six (6) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Continued on LIC 8809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last logged emergency disaster drill was conducted on 09/03/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that they had no recommendations for improvement for the facility. LPA interviewed two (2) staff members. One (1) staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. One (1) staff member interviewed was unable to appropriately identify the different forms of abuse but was knowledgeable on their roles and responsibilities, the resident’s rights, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued. LPA experienced technical difficulties while printing appeal rights. Appeal Rights will be emailed to Licensee at a later date.