Facility Evaluation Report

On 11/5/2025 at 1:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Irene Agamao and explained the purpose of the visit. Administrator, Alejandria Bautista arrived 10 minutes later.

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 8/19/2025. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 108.7 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat/material in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned. First Aid kit is complete. Last fire drill was conducted on 9/18/2025. LPA reviewed 6 residents and 3 staff files starting at 1:50PM. All staff are fingerprint cleared and associated to the facility. LPA reviewed a sample of resident's medications during inspection.

At 2:30PM, LPA observed R6 does not have TB test results on file.

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

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