Routine inspection·November 21, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by an individual named "Jess". Caregiver, Arlina Caranay, contacted the Administrator by phone, Onyx Pacheco. The administrator informed LPA that they would arrive at the facility in a few hours and stated they would contact back up administrator, MayAnn Reyes to assist until their arrival. The back up administrator arrived at the facility at 9:25 A.M. and the Administrator arrived at 2:00 P.M. Reason for the visit was explained Entrance interview conducted. LPA along with back up Administrator conducted a 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 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; facility provides 24/7 care. The following was observed: Fire extinguishers are fully charged and purchased on 05/05/2025. Hardwired combination smoke detectors and carbon monoxide detectors were tested at 10:08 A.M., and all were functional at the time of the visit. Facility is equipped with two (2) fire doors. At the time of the visit, both fire doors were in operable condition. No fire clearance concerns were observed. Bedrooms: The facility consists of four (4) bedrooms in total, of which two (2) are private rooms and two (2) are designated for shared resident use. Bedrooms #2 and #3 are designated for single use and bedrooms #1 and #4 are designated for double occupancy. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Continued on LIC 809-C Continued from LIC 809 Bathrooms: The LPA observed two (2) bathrooms in the facility; one (1) is a shared bathroom for residents’ use only, and one (1) is a staff/visitor bathroom. Resident bathroom was clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Water temperature was measured in the shared resident restroom at 10:05 A.M. and measured at 111.4 degrees Fahrenheit. Kitchen : Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of perishable and non-perishable food supply. All knives and cleaning supplies were observed to be locked and properly stored at the time. All cleaning compounds were stored in areas separately from food supplies. At 10:14 A.M. hot water temperature measured 106 degrees Fahrenheit. Furthermore, laundry area was observed between the kitchen and the visitor/staff bathroom. There, the LPA observed the washer and dryer and locked cabinets. Inside those locked cabinets facility keeps cleaning supplies, disinfectant wipes, dry emergency food and staff and personnel files. LPA observed a low supply of emergency water. Common Spaces: The common areas were checked for cleanliness. At the time of the visit, living room and dining room furniture was observed to be in good condition. Facility maintained a temperature of 74 degrees Fahrenheit. The LPA observed the required postings in the common area. A fireplace was observed to be adequately screened. LPA observed a Ring doorbell at the main entrance. Next to the living room table there is an office space. Medication and a complete first aid kit is kept locked in the office area. Outdoor Space: The front yard is free of obstructions. Both side gates on each side of the facility were self-latching. LPA also observed a patio in the back yard which had shade and seating areas for residents to enjoy. There were no bodies of water noted. Additionally, LPA inspected the detached garage. Garage/Staff Break Room/Storage Room: LPA inspected the detached garage. The garage consists of two (2) back-to-back rooms. The first room stored extra incontinence supplies, extra ambulation devices and a fridge. The second room contained extra ambulatory supplies, furniture and a set of mattresses. Also, there was a closet where emergency supplies were stored. LPA explained to the administrator and backup administrator that no one should be sleeping in this area without a valid fire clearance. Furthermore, LPA discussed whether any modifications made to the facility should be submitted to the department and require permits prior to any modifications are completed. Continued on LIC 809-C Continued on LIC 809-C Record Review: Began at 12:25 P.M., 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. Three (3) resident records were reviewed. LPA observed that Resident #1 (R1) file contained only partially completed forms. The back up administrator explained that R1 was admitted two days ago and that they are in the process of obtaining the remaining documents. The LPA advised that certain documents are required prior to accepting a resident in order to properly assess the individual’s suitability for placement and ensure appropriate care. Five (5) staff records were observed. LPA requested information regarding the individual who opened the door and greeted the LPA upon arrival, and who subsequently exited the facility shortly thereafter through the back of the house rather than the main entrance. The backup administrator reported that the individual was visiting Resident #2 (R2), identifying them as R2’s friend and former neighbor, and stated that the individual does not work as a caregiver at the facility. However, during the brief period the individual was present, the LPA did not observe any interaction between the individual and R2. Additionally, the LPA informed the backup administrator that, while waiting for their arrival, the LPA observed this individual redirecting R1 to sit down to prevent a potential fall, sitting next to R1 to ensure they did not stand up unattended, and assisting them around the facility. LPA requested the individual’s full name and identification card, if available. The back up administrator provided the name of the individual. A review of the Guardian System, using the information provided by the back up administrator, confirmed that the individual is not associated and does not have background clearance or exemption. Medication Review: Began at 2:45 P.M. Medications for three (3) residents were observed. 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. Continued from LIC 809-C Continued from LIC 809-C LPA requested an updated LIC500, Resident Roster, Liability Insurance documents and last emergency drill conducted. Emergency Drills: During last year’s annual inspection, the LPA discussed with the administrator the importance of conducting quarterly emergency drills. At 11:46 A.M., during a phone conversation, the LPA again emphasized that staff and residents must be trained to evacuate, shelter in place or follow any other procedures applicable during an emergency. The administrator was reminded that emergency drills are required by regulation to be conducted quarterly. 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. An immediate civil penalty of $100 was issued and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code § 1569.49 (f). Exit interview conducted, Citations/civil penalties issued /A copy of the report and appeal rights were issued.