Routine inspection·September 30, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived unannounced to conduct a one year required annual at 9:10 A.M. Upon arrival, the LPA was greeted at the door by administrator, Sophia Bonoan, and the reason for the visit was explained. At 10:00 A.M. House Manager, Maria Del Rocio Partida, joined the visit. Administrator stated they had a doctor’s appointment to attend and, in the event, they were not available to sign today’s report, authorized the House Manager or caregiver, Altagracia Luna Naranjo, to sign on their behalf. Entrance interview conducted. At 9:35 A.M., the LPA along with the administrator 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. T his facility doesn’t have a staff room; facility will provide 24/7 care. The following observed: KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food at the time of the visit. All knives, cleaning solutions, and chemicals were observed to be locked under the kitchen sink. At 9:39 A.M. the hot water temperature measured 143.2 degrees Fahrenheit. During today’s visit, the administrator adjusted the water temperature. At 12:38 P.M., LPA rechecked hot water temperature and measured 113.5 degrees Fahrenheit. LPA observed a fire extinguisher fully charged and recently purchased on 08/10/2025. Continued on LIC 809-C Continued from LIC 809 BEDROOMS: There are five (5) bedrooms, which Room #5 is for ambulatory individuals only and Room #1 for double occupancy. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: There are two (2) bathrooms, LPA observed toilets and hand washing stations to be in operation with grab bars and slip-resistant surfaces. Between 9:30 A.M. and 9:55 A.M. Hot water temperature was measured in both bathrooms and measured 141.5- and 140.8-degrees Fahrenheit. During today’s visit, the administrator adjusted the water temperature. At 12:42 P.M. LPA rechecked both bathrooms, and hot water temperature measured 110.1- and 111.7 degrees Fahrenheit. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. A fireplace was noted and was observed to be adequately screened and inaccessible to residents in care. The LPA observed the required postings in the common area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The facility maintained a comfortable temperature of 73 degrees Fahrenheit. Facility has a fire door to contain a fire from one side of the house to the other side. At 10:00 A.M. hardwire smoke alarms and carbon monoxide were tested and found to be functional at the time of the visit. OUTDOOR SPACE: The backyard area contains a shaded area with a table and chairs for residents’ use. Exit gate was observed to be self-closing and self-latching and it was clear and free of hazards. During today’s visit, the front yard passageway was observed to be obstructed by a pumpkin vine. The plant was trimmed, and the passageway was cleared of hazards. Technical Violation (TV) issued. No bodies of water noted at the time of visit. GARAGE: A locked garage is accessible from the interior and exterior of the building. Inside the garage LPA observed an extra fridge, emergency water, emergency food and extra medical supplies. The washer, dryer, cleaning supplies and chemicals are safely stored and inaccessible to residents. All residents’ and staff members’ files were observed to be securely stored and locked in a file cabinet to ensure privacy and confidentiality. Continued on LIC 809-C Continued from LIC 809 RECORDS: Records review began at 11:16 A.M. LPA reviewed three (3) residents’ records for, but not limited to care plans, medical records, admissions agreement, consent forms. LPA observed that Resident #1 (R1) is missing consent forms. A physician’s report dated 01/2025 indicates that R1 is bedridden and does not have capacity for serf-care. However, during today’s visit, LPA observed R1 self-feeding a salad for lunch and repositioning in bed. LPA requested that the administrator update R1’s physician’s report and Needs and Service Plan. Furthermore, Resident #2 (R2) has a Medical Assessment (LIC602A) signed in 09/2025 indicating ambulatory status of bedridden. In addition, Resident #3 (R3), a non-ambulatory individual, was observed occupying room #5 which is designated for ambulatory residents only. At 1:45 PM, LPA reviewed four (4) personnel records including administrator. All staff files were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. LPA requested and received a copy of the current Personnel Record Form (LIC 500). Upon review, LPA compared the LIC 500 with the Guardian background check system and absorbed that Staff# 1 (S1) is listed on the LIC 500 as the House Manager with a Monday through Friday night shift. However, S1 does not have an exemption granted and is not associated with this facility in the Guardian background check system. House manager left the facility at 2:45 PM. Administrator then assigned caregiver, Altagracia Luna Naranjo, will be signing today’s report. All other files were in order. Liability insurance is current. Last emergency drill (Evacuation Plan) was conducted on 06/10/2025. MEDICATIONS: Medications review begin at 2:25 P.M., medications are centrally stored and locked in a hallway cabinet. Medications are labeled and checked for expiration dates. Medications are not being documented on the Centrally Store Medication log, a file containing this form was emailed to the administrator during today’s visit. A first aid kit was observed in the hallway cabinet. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 9099-D). Failure to correct the deficiencies may result in additional civil penalties. A civil penalty in the amount of $500 for a fire clearance and a civil penalty in the amount of $500 for background check violation is being assessed on the attached LIC 421IM and LIC 421 BG. The Administrator was informed that additional civil penalties might be assessed based on health and safety code 1569.49(f) via telephone. Exit interview conducted. Citations issued. A Copy of report and appeal rights provided via email.