Post-licensing visit·October 28, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a post licensing visit. Upon arrival, the LPA was greeted by staff who then contacted the Administrator telephonically. The Administrator, Analyn Cervantes arrived during the inspection and the reason for the visit was explained. Entrance interview. The LPA and 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. Kitchen: The LPA inspected the kitchen/food service area at approximately 10:05 a.m. Knives and sharps were observed in a locked drawer. Cleaning supplies and other chemicals are kept locked under the sink area. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 115 degrees Fahrenheit at 10:07 a.m. Bedrooms: There are six (6) total bedrooms in the facility; Five (5) bedrooms are designated for resident use, and one (1) bedroom is designated for staff use only. Four (4) resident bedrooms are designated as private, single occupancy, resident rooms and one (1) resident bedroom is designated as double, shared occupancy, resident room. Bedrooms #2, #4, and #5 have access to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Additional clean linens and towels are available for resident use. Report Continued on LIC 809C... Report Continued from LIC 809... Restrooms : There are two (2) total restrooms in the facility. One (1) bathroom is designated for resident use, and one (1) bathroom is designated for staff / visitor use only. Resident restroom was observed to be clean and in sanitary condition. Grab bars and slip resistant floor were observed. The restroom was sufficiently stocked with supplies and paper towels. The hot water temperature was measured at 113.7 degrees Fahrenheit, which is between the required range. Garage: The LPA observed the garage which is kept inaccessible to residents in acre. There is a washer and dryer. Toxins and detergents were observed locked and inaccessible at the time of the visit. The LPA observed a sufficient supply of emergency food and water. Common Areas: This includes the living room, family room, and a dining room. 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 hardwire combination of smoke / carbon monoxide detectors and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 08/11/2025. The LPA observed required postings throughout the common space including emergency exiting plans / sketch, emergency telephone numbers, and facility license. Activities were observed in the common areas. There is a functioning telephone on the premises. Outdoors: The backyard has a covered patio area with shade, patio furniture including tables and chairs for resident use. All passageways were observed to be clear. The LPA observed two (2) self-latching gates. No bodies of water noted at the time of the visit. Records Review: The LPA conducted a record review of four (4) resident files and four (4) personnel files beginning at 11:30 a.m. Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, PRN authorization letters, and current needs and services plan. Files were complete. Report Continued on LIC 809C... Report Continued from LIC 809C... Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The LPA was unable to verify training hours for staff during the visit. Infection Control / Emergency Disaster Planning: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures, as they pertain to infection control and emergency planning, adhere to the standard. Medications Review: Medications are centrally stored in a cabinet adjacent to the living room. Medications are labeled and checked for expiration dates. 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. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. Copy of report reviewed and provided.