Facility Evaluation Report

On 10/20/2025, LPA Yi Sam Jian made an unannounced annual visit to the facility. LPA met with staffs, Teresita Elca(S1) and Judith Halili(S2), LPA explained the purpose of the visit. Administrator, Federico M iranda, was not available on-site but was contacted by phone to give permission to S1 to sign report.

LPA toured the facility inside and outside including 4 resident rooms, 3 bathrooms, garage, storage shed in the backyard, and kitchen area. Backyard was fenced, secured, and in good condition. All outdoor and indoor passageway were free and clear of obstruction. No accessible bodies of water or fire safety hazards observed. Kitchen was inspected, sufficient supply of food observed. Infection control practices reviewed. Medications, toxins and sharps stored appropriately and inaccessible to clients, a comfortable temperature was maintained, hot water temperature inspected to be compliant, furnishing and lighting was sufficient for comfort and safety.

Carbon monoxide detector and smoke detector system inspected and met the requirements. fire extinguisher checked and fully charged. Facility has a written emergency disaster plan. Licensee has at least one completed first aid kit located in the office. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed.

Deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. Two technical violations were noted for no documentation for the criminal records for residents at the facility and no documentation for all 6 clients' updated annual reappraisal. This report is reviewed and discussed with the administrator; a copy of the report and appeal rights were provided.