Routine inspection·December 15, 2025

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual inspection. Upon arrival LPA was greeted by staff and entrance interview and introductions conducted. Assistant Administrator Laila Kulungu was contacted and arrived to the facility. At approximately 110:15a.m., LPA and staff 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: Fire extinguisher located in the kitchen was observed fully charge with receipt dated 10/2025. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted in the main hallway area wall. Other required postings are also posted on the main hallway area wall. KITCHEN: Kitchen knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans, and drink ware is adequate. The supply of nonperishable food is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen, and house cleaning supplies are stored and locked under the sink cabinet area. BEDROOMS: The facility has six (6) private residents’ bedrooms, and one (1) staff’ bedroom. All bedrooms observed with required furniture and clean linen. Lighting in the rooms appeared sufficient. BATHROOMS: There are three (3) bathrooms. Hot water temperature was tested in all restrooms and recorded between 109-118 degrees Fahrenheit. COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. Entertainment equipment, books and/or activity supplies observed for residents use. There was sufficient space to accommodate both indoor and outdoor activities. Alarms on all exterior doors were engaged at the time of visit and functional. Garage was observed locked and contained extra food, PPE supplies, cleaning supplies, and water supply. Laundry room observed with supplies and chemicals locked in the cabinets. LPA reviewed the facility emergency disaster and infection control plan with Ms. Kulungu. (Continue to LIC809c) INFECTION CONTROL: 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 it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly as is required. Earthquake and fire drill conducted on 10/1/2025. Smoke/carbon monoxide detectors were tested at 11:15am and observed operable. OUTDOOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio with furniture for residents use. LPA met with all five residents, one family member and two staff. Resident #1 was observed seat belted in a wheelchair. Interview with staff revealed that the family installed the seat belt to prevent resident #1 from falling forward. LPA informed staff that postural devises cannot be used to restrain resident, cannot be used to prevent falls; can only be used to assist in mobility. RECORD REVIEW: Records review began at 11:30a.m.-1p.m.. LPA observed all five (5) resident records for documents including, but not limited to: needs and service appraisals, medical records, admissions agreement, and consent forms. LPA observed three (3) personnel records for documents including, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and required training. Resident and Personnel files reviewed were in order and had no missing documents. MEDICATIONS : Medications are stored inaccessible in locked cabinets in the hallway/office area. Beginning at 1:30p.m.-2:30p.m., LPA reviewed five (5) residents medication and medication records. Medications were observed to be properly documented on the centrally stored medications. One out five residents medications reviewed did not have a prescription for over the counter medication (advil/cough syrup). Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.