Routine inspection·December 18, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:49 AM. LPA met with facility staff who contacted the facility Administrator Herbert Perey. The Co-Administrator Mischelle Perey arrived to the facility at approximately 11:10 AM. LPA and Co-Administrator were later joined by Administrator. Entrance interview was conducted and the reason for the visit was explained. Beginning at approximately 10:50 AM the LPA, along with the facility staff and later the Administrator and Co-Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS : This includes the living room, hallway, and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a television, adequate seating, and locked storage for resident medication and files. Additionally, the living room was observed to contain all required postings, the facility telephone, emergency flashlights, and a complete first aid kit. The hallway was observed to be clean and free from any obstructions. The hallway contained closets that contained storage for linens and care supplies. Additionally, the hallway contained a locked laundry room which contained the facility’s washer and dryer in addition to laundry chemicals and care supplies. The dining area was observed to be equipped with adequate seating for resident use and contained an appropriately screened fireplace. Continued on LIC 809C. COMMON AREAS CONT.: LPA observed the dining area and hallway to contain wall mounted fire extinguishers that were fully charged and last serviced on 05/14/2024 which was more than 12 months from the inspection date. LPA informed the Co-Administrator who purchased new fire extinguishers during the visit and installed them at the facility. The facility’s fire and carbon monoxide alarms were tested at 12:14 PM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured under-sink cabinet to contain cleaning chemicals. LPA observed secured drawers to contain knives and other sharp objects. BEDROOMS : There are four (4) bedrooms in the facility; two (2) are dual occupancy resident rooms, two (2) are single occupancy resident rooms. LPA and the Co- Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS : There are two (2) bathrooms at the facility. One is designated as a shared/common resident bathroom and one (1) is a private resident bathroom. Both resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 129.3 and 133.3 degrees Fahrenheit, whish is outside of the range required by regulations. LPA informed the Administrator who adjusted the temperature regulator on the water heater and agreed to submit proof of appropriate water temperature to LPA. The private bathroom contained a secured storage which contained grooming supplies. Continued on LIC 809C. GARAGE: The garage was observed to be locked and inaccessible to clients in care. LPA observed the garage to contain an extra refrigerator/freezer, extra care supplies, and sufficient emergency water supplies. LPA observed the garage to contain two (2) makeshift bedrooms which included supports, wooden walls, and a door. LPA interviewed the Co-Administrator about the rooms. The Co-Administrator stated that the rooms were installed in June of 2025 and facility staff were utilizing the rooms. The Co-Administrator confirmed that they did not obtain building permits for the two (2) rooms, did not inform Community Care Licensing Division (CCLD) of the construction, and did not obtain a fire inspection for the rooms. LPA informed the Administrator and Co-Administrator that the constructed rooms are a violation of the facility’s fire clearance which is a zero-tolerance violation and an immediate civil penalty of $500 is being assessed on today’s date (12/18/2025). LPA informed the Administrator and Co-Administrator that failure to remove the structures could result in the assessment of additional civil penalties. OUTDOOR SPACE: The facility has one (1) emergency exit gate located on the side of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed cameras throughout the outdoors of the facility. RECORD REVIEW: Record review began at 12:19 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained all required documentation and trainings. Four (4) resident files were reviewed. All resident files contained the required documentation. MEDICATION REVIEW: Medication review began at 01:14 PM. Medications for two (2) of four (4) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Continued on LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last logged emergency disaster drill was conducted on 12/01/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that staff treat them well and are attentive to their needs. The residents interviewed had no concerns with the facility. LPA interviewed two (2) staff members. The staff members interviewed were knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited and civil penalty assessed. (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.