Facility Evaluation Report

On 12/4/2025 at 9:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Sergio Devera and explained the purpose of the visit. Administrator, Corazon Nunez was unable to be at the facility and designated caregiver to sign licensing reports.

LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 6/16/2025. One week of nonperishable and 2-day of perishable food supplies were available. LPA observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. LPA reviewed 4 residents and 3 staff files starting at 10:00AM. LPA reviewed a sample of resident's medications during inspection.

At 11:30AM, LPA observed S2 does not have TB test on file.

At 12:28PM, LPA measured hot water temperature at 129.2 degrees F in the hallway bathroom.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties.

Exit interview conducted with Sergio Devera. A copy of this report and appeal rights was provided.