Overview: Facility is a one-story house located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents, up to 4 may be non-ambulatory. Facility does not have clearance for bedridden, delayed egress, and/or locked exterior and/or interior.

Physical Inspection: Areas inspected include, but not limited to, the kitchen, dining, resident units/bedrooms, resident bathrooms, common areas and outdoor areas.

LPA inspected 3 of 4 bedrooms. One of the bedrooms (Bedroom #4 on the facility sketch) has an exit. In bedroom #4, LPA found resident medications inside the closet. Per review of residents’ medical assessment (LIC602A), at least one resident was assessed to be at risked if they have access to medications and similar items. Two bathrooms were inspected. In one of the bathrooms, LPA found medication in one of the cabinet. Hot water temperature ranged from was measured at 114 degrees Fahrenheit. Hallway temperature was between was maintained at 76 degrees Fahrenheit.

Fire extinguisher was observed in the kitchen and hallways and was last inspected on January 22, 2025. There is a fire door leading to bedrooms #2, #3, and #4. During this visit, the fire door was propped open. Per staff interview, they keep this fire door open at all times. Staff closed the fire door during this visit. Smoke and carbon monoxide detectors were observed throughout.

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• 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.

In the kitchen area, LPA observed at least seven-day non-perishable and two-day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Kitchen refrigerator and freezer were maintained at regulatory temperature.

The outdoor areas: LPA observed shade area and outdoor furniture for residents use. Ramps were observed to be in good repair at this time. Emergency walkways were observed to be unobstructed. Fence and gate were in good repair. Advisory provided to licensee to ensure they know the location of each shut off valves and how to operate each one in case of emergency. Advisory also was provided for staff to remove the extra locking mechanism of the exit gate.

Record Reviews: LPA reviewed 4 resident files and 2 staff files

Review of resident files, including but not limited to, review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. LPA reviewed 1 of 5 resident medications. Advisory given for staff to obtain PRN Authorization Letter for all residents. At least one resident did not have a completed Care Plan (LIC625).

Review of staff files included, but not limited, background clearance, First Aid/CPR certificate, Health Screen, Initial Training. Per review of Guardian, 2 staff on duty are associated with this facility.

Review of fire drill/disaster drill records: facility conducts quarterly drills and last drill was conducted on 4/22/2026.

Documents Requested: LPA requested a copy of current LIC500, LIC308 and Liability Insurance Certificate to be emailed at arvin.villanueva@dss.ca.gov

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were cited at this time. Advisories were provided. Immediate Civil Penalties were assessed in the amount of $500 during this visit for violation of fire safety.

Exit interview was conducted. A copy of the report was provided upon exit.

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