Facility Evaluation Report
On October 14, 2025, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by caregivers, Jeffrey Medina and Marc Medina. LPA explained the purpose of today's visit.
LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, garage and backyard. This is a single story home with 5 resident bedrooms(4 private and 1 semi-private), 2 full bathrooms, and 1 staff room. The indoor and outdoor passageways were free of obstruction. The facility observed to clean, tidy and in good repair. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid mats. Facility temperature is comfortable. Hot water temperature was measured at 106-110 degrees F.
Central stored medication were observed to be locked and inaccessible to residents. Food supplies were observed to be adequate,
Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguisher was last serviced Oct 8, 2024. Fire drill records were reviewed to be adequate.
A review of (5) resident files was conducted and noted on the LIC 858.
A review of (2) staff files was conducted and noted on the LIC 859.
The following document is requested to be submitted to CCL by 10/16/2025
Administrator Certification, LIC 400, LIC 500, LIC 402 (Surety bond) LIC 308, and LIC 309.
No deficiency is cited today. This report is reviewed and discussed with the caregivers.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction