Routine inspection·May 12, 2026

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit today. Upon arrival, the LPA was greeted by staff who then contacted the Administrator telephonically. The Administrator, Ivy Sudjati arrived during the inspection and the reason for the visit was explained. Entrance interview conducted. Beginning at 10:03 a.m., the LPA along with 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: Kitchen: The LPA inspected the kitchen/food service area at approximately 10:05 a.m. Knives and sharps were observed in a box locked under the kitchen sink. Cleaning supplies were observed locked and inaccessible under the kitchen sink at the time of the visit. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The LPA observed an adequate amount of emergency food and water. At 10:08 a.m., the hot water temperature was measured in the kitchen sink at it measured at 115 degrees Fahrenheit. Common Areas: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed several fire extinguishers to be fully charged with a charge date of 03/23/2026. Required postings were observed throughout the common space. There is a working telephone on premises. The LPA observed cameras in the common areas. First aid kit was observed to be complete. No hazards/obstructions observed inside or out. Report Continued on LIC 809C... Report Continued from LIC 809... Restrooms: There are three (3) restroom for resident use. Bathroom was clean and sanitary and in operating condition with non-skid surfaces and grab bars. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 10:12 a.m., the hot water temperature was measured in resident bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit at the time of the visit. Personal hygiene items were observed locked at the time of the visit. Bedrooms: There are six (6) bedrooms for resident use. Bedrooms are designated as private / single bedrooms. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Additional clean linens and towels were observed in a cabinet by the hallway. Garage: The garage is attached to the facility. Detergents and cleaning supplies were observed locked and inaccessible to residents in care at the time of the visit. The LPA observed a sufficient amount of Personal Protection Equipment (PPE). Laundry Room: The washer and dryer were observed in a closet adjacent to the office. Outdoors: The backyard has a covered patio area with adequate furniture for resident use. Emergency passageway was observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms. No bodies of water noted at the time of the visit. Records: Record review began at approximately 10:45 a.m. Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, preplacement appraisals, appraisals, and current needs and services plan. All files were in order. Four (4) personnel files were reviewed for, but not limited to: personnel records, health assessments with negative TB test results, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All personnel files were complete. Report Continued on LIC 809C... Report Continued from LIC 809C... Medications: Medication review began at approximately 12:05 p.m. Medications are centrally stored and kept in a locked cabinet adjacent to the living room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appear to be administered as prescribed at the time of the visit. Infection Control / Emergency Disaster Planning: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as they pertain to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; last disaster drill conducted on 02/12/2026. No citations issued at this time. Exit interview conducted. A copy of the report was issued.