Routine inspection·March 19, 2026

At 10:00 A.M., Licensing Program Analysts (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit. The LPA met with caregiver, Maria Partida and explained the reason for the visit. Caregiver contacted the Administrator, Sophia Bonoan via telephone. At 10:40 A.M. the Administrator arrived at the facility. LPA explained the reason for the visit to the Administrator. At the time of the visit there was one (1) caregiver and three (3) residents. Entrance interview conducted. At 10:42 A.M., the LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. Fire extinguishers are fully charged and recently purchased on 02/26/2026. Hard-wired smoke detectors and carbon monoxide detectors were tested at 10:52 A.M and were operational at the time of the visit. The facility is equipped with a fire-rated door designed to enhance safety and prevent the spread of fire. However, during the smoke alarm test, the fire-rated door separating the resident rooms and the hallway leading to the common areas did not function properly, as it failed to automatically activate and close. KITCHEN: The LPA observed a locked cabinet beneath the sink containing knives and other sharp objects stored in a container. Cleaning supplies were also stored next to the container. These items were secured and inaccessible to residents in care. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:05 A.M., hot water measured at 113.4-degree Fahrenheit. Continued on LIC 809-C Continued from LIC 809 COMMON AREAS: Shared facility space includes a common living room, activity room, and dining area. The LPA observed common areas to be properly furnished and in good condition. The facility has a dual-sided fireplace, which LPA observed to be properly screened. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. Medications and first aid kit are located in a locked hallway closet. LPA observed a working telephone on premises and all required postings on the facility wall. Additionally, the LPA observed clean linens and towels in the hallway closets. BEDROOMS: The facility is a single-story residential home. The facility consists of 5 total bedrooms – four (4) are private resident rooms and one (1) is a shared resident room. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. BATHROOMS: There are two and a half (2 ½) bathrooms in the facility for resident use. Two (2) full bathrooms were observed to be equipped with slip-resistant surfaces and contain slip-resistant mats. Grab bars were observed in the all bathrooms. The water temperature was measured in all bathrooms and measured within the required range. OUTDOOR SPACE: The LPA observed the back patio which has a covered outdoor area with patio furniture including a table and chairs for resident use. There are two gates on the side of the house designated for an emergency exit. The LPA observed a non-operable water fountain in the backyard, with no water present inside the fountain during today’s visit. GARAGE: The garage is attached to the house and remains inaccessible to residents. The garage was locked and contained emergency disaster supplies such as food and emergency water, PPE, locked chemical storage, an extra refrigerator/freezer, washer and dryer. Continued on LIC 809-C Continued from LIC 809-C RECORD REVIEW: Starting at 11:25 A.M., a file review for 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, and personal rights. The LPA reviewed records for five (5) staff including the Administrator. During the audit, the Administrator did not have all required documentation readily available for LPA review. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. LPA did not observe a current Needs and Service Plan for Resident #1 (R1). Technical Violation (TV) issued. All other files were in order. Administrator’s Certificate is valid until 03/29/2026. MEDICATION REVIEW: Medications are centrally stored and locked in a hallway cabinet; medications are labeled and checked for expiration dates. At the time the medication audit was initiated, the LPA observed that the facility had a Centrally Stored Medication and Destruction Record (LIC 622) on file, however, the information contained within the document was outdated. According to the Administrator, they had been advised to rely on the Medication Administration Record (MAR). The Administrator requested assistance in completing the LIC 622 form. The LPA provided guidance on how to properly complete the form and also provided the Administrator with the TSP contact information and phone number for further support. Medications were observed to be administered as prescribed during today’s visit. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated. The last emergency drill was conducted on 12/20/2025. A Technical Violation was issued for not conducting emergency drills during 2025 annual visit. LPA provided the Administrator with the following contact information for TSP services. TSP email address TechnicalSupportProgram@dss.ca.gov and their phone number (916) 654-1549. Additionally, LPA advised the Administrator to review the Provider Information Notices (PINs) on CCLD's website ( www.ccld.ca.gov ) for further guidance and updates. Continued on LIC 809-C LIC 809-C During today’s visit, the LPA obtained a copy of the current liability insurance, Personnel Report (LIC500) and Resident roster. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 809-D.) A civil penalty was issued in the amount of $500 for fire safety issues. Administrator was informed that failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.