Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Hood arrived at the care home unannounced on June 17, 2026 to conduct a Required-1 Year Inspection utilizing the inspection tool.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 117 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on site. LPA observed the backyard and perimeter of the care home and observed emergency exits to be unobstructed. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA checked two (2) residents' medications, six (6) resident files, and three (3) staff files. Facility has a current copy of certificate of liability insurance and LPA requested a copy.

As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87465 due to medications being accessible to residents in staff bedroom, and Section 87303 due to cleanliness and repair of the care home, including backyard fence in disrepair, debris in backyard, interior floors in disrepair, dishes in kitchen sink, and dish washer in disrepair . Deficiencies are listed on 809-D pages. Exit interview was conducted. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.