Routine inspection·September 9, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct the required annual visit at 10:45 A.M. When the LPA arrived, there was one (1) staff member and three (3) residents present. The LPA was greeted by Caregiver, Araceli Camarillo, and informed them the reason for the visit. Caregiver contacted the Administrator by phone, Sara Jackson. At 11:30 A.M., the Administrator arrived at the facility. During today’s visit, the administrator was required to attend an emergency and authorized the caregiver to sign today’s report on their behalf. At 11:45 A.M., the LPA conducted a tour of the physical plant with the Administrator, to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. This facility doesn’t have a staff room; the facility will provide 24/7 care. The following was observed: Kitchen : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food as well as emergency food. At 11:55 A.M. hot water temperature measured at 112.2 degrees Fahrenheit. Continued on LIC809-C Continued from LIC 809-C Bedrooms: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) bedrooms in total; 4 (four) are private bedrooms and one is designated as a shared room. No bedroom was used as a passageway to another room, bath, or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Restrooms: The LPA observed four (4) restrooms in the facility; two (2) are shared resident restrooms, one (1) is a private restroom, and one (1) half bath is designated for staff and visitor use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip-resistance surfaces. Water temperature was measured in the common resident restrooms and was within the required range. Common spaces: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, the living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. The facility maintained a comfortable temperature of 71 degrees. Facility provides sufficient space to accommodate both indoor and outdoor activities. The fire extinguishers are fully charged and recently purchased on 07/07/2025. Hardwired combination smoke/carbon monoxide detectors were tested at 1:15 P.M. and were operational at this time. Facility is equipped with a fire door to enhance safety and prevent the spread of fire. During today’s visit, fire door was observed closed. Outdoor Space: The backyard area contains a shaded area with a table and chairs for resident use. There is a non-functioning fountain, which was observed to be empty at the time of the visit.There were no bodies of water noted. Facility has two total gates; both were observed to be self-closing and self-latching gate with clear passageways for emergency exit use. LPA observed a back house where gardening tools and other supplies are stored. Continued on LIC 809-C Continued from LIC 809-C Garage/Office: The garage is where the washer and dryer are held, including emergency food and emergency water. Cleaning supplies, disinfectants, sharps and knives were observed to be locked in a cabinet in the garage. All cleaning compounds were stored in areas separately from food supplies. There is an office area whit a desk and a phone and files are held. File review: A review of facility files was initiated at 12:20 P.M. and the following was observed. LPA reviewed three (3) residents files. LPA observed that one (1) resident medical assessment indicated that residents have no capability for self-care, and they are not on hospice, and there were no records indicating that an exception request was submitted to the department. All other required forms were complete. Additionally, LPA reviewed three (3) staff files including the administrator’s. All documents reviewed appeared complete and current. Last fire drill conducted on 07/06/2025. LPA obtained Client Roster, Staff Roster, and Liability insurance. Medication review: Began at 1:45 P.M.; medications are centrally stored and locked under the kitchen counter; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.