Routine inspection·July 23, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:52 AM. LPA met with facility staff who contacted the facility Administrator Edwin Paul Oyasan. The Administrator arrived to the facility at 11:03 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 11:05 AM the LPA, along with 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: KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. The kitchen contained a locked under-sink cabinet containing cleaning supplies. COMMON AREAS : This includes the living room and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains activities for resident use. The dining area was observed to be equipped with adequate seating for resident use. The facility’s combination fire and carbon monoxide alarms were tested at 11:44 AM 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. BEDROOMS : There are five (5) bedrooms in the facility; one (1) is a dual occupancy resident room and four (4) are single occupancy resident rooms. LPA 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. All five (5) bedrooms contained a direct exit to the outdoors of the facility. BATHROOMS : There are two (2) bathrooms at the facility. One is designated as a shared/common resident bathroom and one is a private resident bathroom. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Both bathrooms contained locked under sink storage cabinets that contained resident grooming supplies and cleaning supplies. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. Water temperature was measured to be between 118.2 and 118.9 degrees Fahrenheit, which is within the range required by regulation. 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 has adequate shaded seating outdoors for resident use. LPA observed two (2) secured storage sheds that contained miscellaneous care supplies, paints, and gardening supplies. OFFICE: LPA observed the office to be locked and inaccessible to clients in care. The office was observed to contain locked cabinets that contained resident medications and facility files. Additionally, the office contained a locked refrigerator for resident medications and the facility’s complete first aid kit. LPA observed a fire extinguisher mounted on the wall to be serviced on 06/03/2025 GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. LPA observed the garage to contain extra cleaning supplies, emergency food and water supplies, and additional care supplies. Additionally, the garage contained an extra refrigerator. LPA observed an additional fire extinguisher mounted on the wall to be serviced on 06/03/2025. Continued on LIC 809C. RECORD REVIEW: Record review began at 11:45 AM. 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. Two (2) staff files were reviewed. All staff files contained all required documents and trainings. Five (5) resident files were reviewed. Three (3) resident files, were observed to be missing records of their personal property inventory at the time of admission. LPA informed the Administrator who agreed to complete a personal property inventory for the identified individuals. MEDICATION REVIEW: Medication review began at 11:20 AM. Medications for two (2) of five (5) 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. 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 it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 05/30/2025. 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 one (1) resident. The resident interviewed stated that the staff treat them well and are attentive to their needs. The resident interviewed had concerns with the facility. LPA interviewed one (1) staff member. The 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 During today’s visit LPA obtained a copy of the facility’s resident roster and LIC 500. LPA attempted to obtain a copy of the facility’s current liability insurance. LPA was informed by the Administrator that the facility does not currently have active liability insurance. LPA informed the Administrator that facilities are required to maintain active liability insurance while in operation. The Administrator expressed understanding and agreed to obtain active liability insurance and send proof to LPA. 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 and appeal rights provided.