Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.

LPA met with Peter Reboja, who stated the administrator would arrive shortly. LPA observed (2) residents present in the common area and (2) residents resting in their rooms. The facility is licensed for (5) non-ambulatory residents and has a hospice waiver for (2). Currently, there is (1) resident on hospice. LPA observed a hospice staff and Physical Therapist present during today's inspection.

LPA and Administrator toured the interior/exterior of the facility including the common areas, (3) resident bedrooms, (2) full bathrooms, kitchen, and locked laundry area on the first floor. The second floor of the facility is used by the Administrator. LPA observed the bathrooms to have the necessary grab bars, skid-resistant flooring, hygiene supplies and trash can. LPA observed sufficient 2+day perishable, including

fresh produce, and 7+day non-perishable supply of food. Sharps and medications not requiring refrigerations are locked in the kitchen, and toxins are secured in the laundry area. Fire extinguisher was last serviced 9/22/2025, and the smoke monoxide alarms are working. There are required postings in the common area, including Resident Rights. The facility completed the last fire drill in January 2026. Inside temp measured 73*F . Hot water measured 127*F in a resident bathroom- a sign is posted. Facility to monitor the temperature monthly. There is (1) unlocked gate from the inside back patio.

LPA reviewed (2) resident files and (3) staff files. Medications were reviewed for (2) residents- orders match medications being administered. Staff have current First Aid/CPR certifications. (2) staff have current RCFE Administrator certifications. Administrator RCFE Administrator certification #7003027740 (exp 2/10/2028). All staff is cleared/associated. LPA to provide additional resources by email. Discussed various topics also.

Per California Code of Regulations Title 22, (1) deficiency is issued on the 809-D page.

Exit interview. Copy of report and appeal rights provided to the Administrator.