Routine inspection·December 22, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit today at 10:00 a.m. Upon arrival, there were two (2) staff and four (4) residents present. The LPA was greeted by facility staff, Jackie Olivera and the reason for the visit was explained. Caregiver contacted the Administrator by phone, Lidia Medina. At 10:50 a.m. Administrator arrived at the facility. Entrance interview conducted. Starting at 10:55 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. The following was observed: BEDROOMS: There are four (4) resident bedrooms. Two (2) bedrooms are single occupancy, and two (2) bedrooms are double occupancy. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. T his facility doesn’t have a staff room; facility will provide 24/7 care. 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 the fire extinguisher to be fully charged with a service date of 03/15/2025. Required postings were observed throughout the common space. Continued on LIC 809-C Continued from LIC 809 The LPA observed a fireplace adequately covered at the time of the visit. Activities were observed in the living room and dining room. There is a working telephone on premises. The LPA observed additional clean linens and towels for resident use. Auditory alarms were observed at the time of the visit. Hardwired combination smoke and carbon monoxide detectors were tested at 11:05 A.M. and were functional at the time of the visit. BATHROOMS: There are two (2) bathrooms designated for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Beginning at 11:00 a.m., LPA measured the hot water temperature in both bathrooms. The hot water temperature in the shared bathroom measured 108.7. The hot water temperature in the master bedroom measured below the required regulatory standard. Per the Administrator, an individual water heater was recently installed, and staff are in the process of adjusting the temperature to meet regulatory requirements. Technical assistance (TA) issued. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed locked and inaccessible under the kitchen sink. 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. At 11:13 a.m., the hot water temperature was measured in the kitchen sink, and it measured at 108.6 degrees Fahrenheit. GARAGE: The garage was locked and inaccessible to residents at the time of the visit. The LPA observed an adequate amount of emergency food and water. Washer and dryer were observed inside the garage. Additional cleaning supplies are kept in the garage locked and inaccessible to residents in care. BACKYARD: The backyard has a covered patio area with patio furniture for residents’ use. All passageways were observed to be clear of any obstructions. There is one (1) side gate with latching mechanisms. No bodies of water noted at the time of the visit. LPA observed a locked shed where mobility devices are stored. Continued from LIC 809-C RECORDS: Beginning at 11:45 a.m., LPA reviewed Resident Records. and Personnel Records. Four (4) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. LPA observed that three (3) out of four (4) residents did not have a current Needs and Services Plan on file. Three (3) personnel and current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All records were in order. Current Administrator’s Certificate is valid until 05/21/2026. MEDICATIONS: Medications review began at approximately 1:50 p.m. The medications are locked in a cabinet adjacent to the dining room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appeared to be given 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; the last one being a fire drill which was conducted on 12/02/2025. During today's visit, LPA gathered the following items: Personnel Record (LIC500), Facility Roster (LIC9020A). A copy of the facility's liability insurance. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.