Facility Evaluation Report

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced annual inspection at the facility. Upon arrival, LPA Haddadin was greeted by care staff member Diana Querubin, who granted entry into the facility. LPA Haddadin explained the purpose of the visit. The facility is licensed for six (6) non-ambulatory residents and has a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood and consists of five (5) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, a living room, a dining room, a kitchen, an attached garage, and a covered outdoor patio area. At the time of the visit, there were five (5) residents in care. During the visit, LPA Haddadin toured the facility and inspected the physical plant. The inspection included testing all smoke detectors, checking the hot water temperature in both resident bathrooms, and verifying the functionality of auditory devices on all exits. The hot water temperature measured between 115.9 degrees Fahrenheit and 117.8 degrees Fahrenheit. All smoke detectors were tested and found to be operational. The fire extinguisher was observed to be fully charged and was last serviced on May 6, 2026. The facility’s most recent disaster drill was conducted on April 5, 2026. LPA Haddadin inspected the facility’s food supply and confirmed that the facility maintained the required minimum two-day supply of perishable food and seven-day supply of non-perishable food. LPA Haddadin also observed that medications were secured and inaccessible to residents in care. Cleaning supplies, chemicals, and sharps were locked in kitchen cabinets and inaccessible to residents. LPA Haddadin reviewed two (2) staff files and two (2) resident files. The files reviewed were observed to be current and up to date. Based on the observations made during this visit, no deficiencies were cited per California Code of Regulations, Title 22. An exit interview was conducted with care staff member Diana Querubin, and a copy of this report was provided.