Facility Evaluation Report

On 5/5/2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced Case Management Health and Safety visit to follow up on an incident report that was report to CCL. Upon entry, LPA was greeted by Registered Nurse Araceli Aguilar and Administrator Assistant, Julie Gossage and LPA explained the purpose of today's visit. The administrator arrived towards the middle of the visit and assisted with the rest of the visit.

During the visit, the administrator assistant provided a tour of the facility and LPA observed the exit door by room 103 was broken and not able to close, LPA observed 3 rooms (205, 303, and 305 ) were converted into staff rooms and staff #1 (S1) reported that the resident's shower room by the bathroom is being shared with the live-in staff members; LPA observed the laundry room consisted of chemicals was unlocked and unattended by staff; LPA observed bath tub in the shower room between room 301 and 302 was dirty, brown stains by the grab bar, hair inside the tub, white particles around the faucets and no non-skid mat; LPA observed resident #1 (R1) and resident #2 (R2) required oxygen and there was no “no smoking sign” posted, LPA observed resident #3 (R3) has a prohibited health condition in which the facility did not notify CCL and requested for an exception.

LPA requested for an updated facility sketch reflecting the current room status as some of the resident rooms were converted into staff rooms and provide a copy of the updated sketch to CCL by 5/14/2026.

Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties.

This report is reviewed and discussed with the administrator.