Facility Evaluation Report

Licensing Program Analysts (LPAs) Nancy Guillen and Hanna Gough made an unannounced visit to the facility for the purpose of conducting a POC inspection visit to verify correction of citations issued during the annual visit conducted on June 9, 2026 and POC visit from June 17, 2026. LPAs arrived at the facility and were greeted at the door by caregiver and granted entry. LPA met with Administrator Theresa Kholoma and explained the nature of today’s visit. Based upon this inspection, LPA observed the following:

*Deficiency cited under Title 22 Regulation 87555(b)(27) has been cleared. LPA observed the kitchen to be clean ed and a pest control service agreement has been entered with pest control service company TheBugMan for quarterly service.

*Deficiency cited under Title 22 Regulation 87465(e) has been cleared. Doctor's orders for Over the Counter Medication has been provided and placed in resident file.

*Deficiency cited under Title 22 Regulation 87465(h)(2) has not been cleared. LPAs observed accessible medications in the unlocked garage fridge, kitchen cabinet and a dining room drawer. LPAs had staff remove all medication and place in a locked medication cabinet. A Civil Penalty was assessed.

*Deficiency cited under Title 22 Regulation 87309(a) has not been cleared. Kitchen knives were stored in an unlocked kitchen cabinet. A Civil Penalty was assessed.

Based on today's visit citations have been cleared and notated with civil penalties assessed per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with clearance letters, LIC809D, LIC421F and appeal rights were left at the facility.