Routine inspection·November 14, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit at 9:00AM. Upon arrival, LPA was greeted by the Administrator, Maria Calles, and at this time the reason for the visit was explained. Entrance interview conducted. Beginning at 09:05AM, the LPA along with the Administrator 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. The following was observed: Kitchen: The LPA inspected the kitchen/food service area at approximately 09:18AM. Knives and sharps were observed locked and inaccessible under the kitchen sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Common Areas: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be fully charged with a date of 05/06/2025. Required postings were observed throughout the common space. There is a working telephone on premises. Cameras observed in the common areas. The LPA observed a fireplace in the living room adequately screened at the time of the visit. Activities were observed in the living room. No hazards/obstruction observed inside or out. Continued on LIC 809C... Continued from LIC 809... Restrooms: There are two (2) restrooms for resident use. The first bathroom is located by the main hallway, and the second bathroom is located in bedroom #4. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 09:12AM, the hot water temperature was measured in bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit. Bedrooms: There are four (4) bedrooms for resident use. Two (2) bedrooms are designated as double / shared occupancy, and two (2) bedrooms are designated as private rooms. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. Additional clean linens and towels were observed in a closet by the main hallway. Garage: The garage was inaccessible to residents in care at the time of the visit. There is a second refrigerator with additional food for residents; adequately stored. The LPA observed an adequate amount of emergency food and water. Washer and dryer were observed inside the garage. Additional cleaning supplies are kept in the garage locked and inaccessible to residents in care. Outdoors: The outside perimeter of the house is fenced. The backyard has a covered patio area with patio furniture for resident use. All passageways were observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms. No bodies of water noted at the time of the visit. Records: Record review began at approximately 09:30AM. Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Continued on LIC 809C... Continued from LIC 809C... Record review revealed that one out of five residents has no capacity for self-care and is no longer on hospice. The Administrator stated that resident was discharged from hospice and placed on home health. 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. Four (4) 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 Administrator’s Certificate is valid until 10/21/2026. Infection Control / Emergency Disaster Planning: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as they pertain to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; the last one was conducted on 08/29/2025. Medications: Medications review began at approximately 11:30AM. Medications are centrally stored and kept in a locked file cabinet by the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appear to be administered as prescribed at the time of the visit. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies are cited (refer to LIC809-D). Failure to correct deficiencies may result in civil penalties. Exit interview conducted. A copy of report and appeal rights were provided.