Facility Evaluation Report

On 10/21/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPA initially met with staff on duty and stated the purpose of the visit. The Facility Manager, Josephine (S1) was notified and arrived shortly after.

Initial Observation : Present upon arrival were 2 residents in care with 2 staff on duty. The other 4 residents were out in the community. Room temperature was at 78 degrees Fahrenheit.

Physical Inspection : Areas inspected include, but not limited to, the resident bedrooms, resident bathrooms, living room, kitchen and dining room and outdoor areas. Rooms #1 & #4 are designated as staff/office; rooms #2, 3, & 5 are shared resident bedrooms. Hot water temperature was taken in the hallway bathroom, at 112 degrees Fahrenheit. Fire extinguishers were observed and last serviced on 5/6/25. Fireplace was screened. Medications, cleaning supplies, sharp objects and other dangerous items were locked and inaccessible to residents in care. Emergency walkways were unobstructed. Shut off valves were located. Fence and gates were in good repair at this time. No bodies of water.

Record Reviews: Review of 3 of 3 resident files, included, but not limited to, review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. 2 resident medications were reviewed. Resident cash was also reviewed for 2 residents. Review of 3 staff files included, but not limited to, review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. LPA also reviewed fire drill/disaster drill records; facility conducts monthly drill. First Aid kit was reviewed and complete at this time. LPA requested a copy of current Liability Insurance Certificate, LIC500, LIC308, and Surety Bond during this visit.

Interviews: LPA interviewed 2 staff (S1 and S2). Residents present during this visits are non-verbal.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were cited. Exit interview was conducted. A copy of the report was provided upon exit.