The facility’s fire clearance is approved for six (6) residents age 60 and over, including up to four (4) non-ambulatory residents, of whom one (1) may be bedridden. The facility also holds a hospice waiver for six (6) residents.

At the time of inspection, two (2) residents were under hospice care.

Facility Tour & Observations:

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Physical Plant

The facility is located in a residential neighborhood and is a single-story home consisting of five (5) resident bedrooms, one (1) caregiver bedroom, three (3) bathrooms, including one private caregiver bathroom, a living room, family room, kitchen, dining area, attached garage, front yard, and backyard.

All bedrooms observed contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. LPA observed that sharps, cleaning supplies, and other toxic substances were inaccessible to residents. Sharps were stored in a kitchen drawer and cleaning supplies were secured in the locked laundry room.

Bathrooms were observed to be clean and equipped with required grab bars near showers and toilets, as well as non-skid mats. Hot water temperature was observed outside the required regulatory range of 105°–120°F.

Extra linens and towels were available and stored in hallway and restroom cabinets. Smoke and carbon monoxide detectors were tested and found operational. Fire extinguishers were observed and available. (continued on 809C)

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Food Service

Refrigerators and freezers were maintained at proper temperatures (refrigerators at a maximum of 40°F and freezers at 0°F) and contained a sufficient supply of food, including at least two (2) days of perishable food and seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were stocked.

Health-Related Services & Records

Four (4) resident files were reviewed. Files contained current required documentation including Admission Agreements, signed consents, Needs and Service Plans, Physician’s Reports documenting TB results and ambulatory status, and Resident Rights acknowledgments.

Three (3) residents’ medications were reviewed. Medications were observed to be centrally stored in a locked in the laundry room area.

Disaster Preparedness

Last fire/earthquake drill was conducted on May 2, 2026, with logs available. LIC 610D Emergency Disaster Plan was in process of being updated. Emergency supplies (water, food, flashlights, batteries, first aid) were observed.

Personnel Records & Training

Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Toby Miclat was valid through October 12, 2027.

An exit interview was conducted with Jason Desamero, Caregiver . During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided.