Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Facility staff, Gaudiosa Cauntay, Continual Administrator's Certification for Licensee Melinda Tamonte, expires 04/06/2027. There are currently 4 residents who reside at this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. LPA reviewed 3 resident files, 3 staff files, facility Plan of Operation, Infection Control Plan, and Emergency Disaster Plan.

LPA observed cleaning chemicals inside resident bathroom unlocked and accessible to residents. LPA observed facility hallway fire extinguisher shows full, but was last checked on 10/24/2024. LPA observed the facilities Emergency Disaster Plan does not have correct current State Licensing Regional Office listed. LPA observed the liability insurance plan inside Plan of Operation binder expired 10/04/2025. The facilities Emergency Disaster Plan's evacuation "assembly point" is listed as the "hallway."

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Facility staff, Gaudiosa Cauntay , and copy of report left at facility