Routine inspection·November 3, 2025

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required 1 Year inspection at the facility today. The LPA met with staff and explained the reason for the inspection. When the LPA arrived there were two staff and six residents present. Administrator Arlene Martinez arrived shortly after. The administrator had to leave at approximately 2PM and designated Carestaff Grace Natividad to review and sign the report. RECORDS: The LPA initiated a record review. Facility records are stored in a locked medication closet. The LPA observed documentation of Infection Control, Disaster prevention, Emergency and Disaster Plan and last Disaster drill (conducted in 07/2025). The LPA obtained Client Roster, and Staff Roster . The LPA reviewed five (5) out of six (6) resident files and five (5) out of eight (8) staff files. The following was observed: Two (2) residents did not have the Consent for Emergency Medical Treatment form LIC627C on file, one (1) resident did not have an annually updated appraisal/needs and service plan on file, and two (2) residents did not have signed personal rights forms on file. Additionally, two staff did not have a criminal record statement on file and one (1) staff did not have any documentation of medication training. MEDICATIONS: Medications are locked and centrally stored in a closet in the hall. LPA reviewed medications which appear to be given as prescribed. All medications are labeled and maintained in compliance with label instructions, and state and federal law. All medications reviewed were recorded on the centrally stored medication and destruction record. At 2:10 p.m. the LPA toured the physical plant areas inside and outside, with staff to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Report will continue on LIC809-C, 2nd page. KITCHEN: LPA inspected the kitchen. Knives and cleaning supplies are stored inaccessible in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food and food was stored at appropriate temperatures. BEDROOMS: The four resident bedrooms were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. This facility has a staff/office room adjacent to the kitchen. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detectors and carbon monoxide detector were tested and were operational at the time of the visit. The facility has a fire extinguisher, fully charged and with the last purchased date of 10/23/2025. The LPA observed required postings throughout the common space. No bodies of water noted. RESTROOM: The facility has one common restroom and one private restroom for residents' use. Restrooms were observed to be clean and sanitary with hand soap and paper towels. The washer and dryer are in the hallway in a locked closet. There is water and additional food located in the garage. Infection control practices were discussed. The facility has a sufficient supply of Personal Protective Equipment (PPE). INTERVIEWS: The LPA conducted two (2) resident interviews. No concerns were voiced. 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 provided.