Routine inspection·September 11, 2025

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced required annual visit to the facility. LPA met with the administrators Susana Vincecruz and Roberto Ramirez and explained the reason for the visit. The LPA 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: BEDROOMS: There are four resident bedrooms (two shared and two individual rooms). The resident rooms are set up with appropriate furnishings, clean linens, and sufficient lighting. At 12:32 p.m. the LPA observed 2 tubes of triad hydrophilic wound dressing, 1 tube of neosporin, one bottle of dermal wound cleaner, 2 bottles of Pepcid complete, one bottle of Dulcolax stool softner, 1 bottle of diabetic Tussin, and one box of Chloraseptic sore throat +cough in room #4, however per the resident's (R1's) LIC602 they cannot manage or store their own medications. RESTROOMS: There are two bathrooms at the facility. The restroom has grab bars and a shower with non-skid materials. The hot water temperature measured within the required temperature. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. The LPA observed the required postings. The fire extinguisher appeared fully charged and was last purchased on 09/15/2024. The facilities smoke detectors and carbon monoxide alarms were tested throughout the facility and functioned properly at the time of visit. Report will continue on LIC 809 - C. The garage, which has laundry equipment, was observed locked and contained laundry supplies. The garage is also used by staff as a break area and storage area for their personal items. The outdoor patio has a covered area equipped with furniture for resident use. There were no bodies of water noted. At 12:40 p.m. the LPA observed the foyer exit blocked with various items on the floor, such mattresses, clothing and shoes, the LPA also observed knives, chemicals, gardening equipment, clothing, canned food, and a cooking pot with an unknown substance inside. The foyer fence was also observed to be locked with a paded lock. Upon observation, the lock was removed. KITCHEN: Kitchen knives are stored in the locked drawer in the kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. RECORDS: A review of facility files was initiated and the following was observed. The LPA reviewed five (5) of six (6) resident Files. Out of the five files reviewed, the LPA identified that R2's and R3's LIC602 were from 2023 and did not have a medical assessment within the past year on file or documentation of resident's refusal to receive an annual routine visit or their representative's refusal on their behalf. The LPA also identified that R4's ambulatory status is bedridden per the LIC602, however the facility is only licensed and fire cleared for 6 non-ambulatory residents and is not license/ fire cleared for any bedridden residents. INTERVIEWS: Interviews were conducted with two residents No issues or concerns revealed. Due to time constraints the LPA will return at a later date to complete the annual. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were issued.