Facility Evaluation Report

On 07/20/26 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA contacted Administrator, Mariana Alba, who arrived some time later. LPA explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. There were no residents present during todays visit.

Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced on 11/10/25. Last fire drill on conducted on 01/04/26. Resident rooms observed to have the required furnishings and with adequate lighting. Sharps, chemicals and medications were located in locked cabinets/closets and cupboards. LPA observed sufficient seating under covered patio areas.

The following issues were observed during today’s visit: The emergency and disaster plan did not have transportation number(s) listed. 1 shelter location not outside the immediate area. Instruction for use were not provided for utility shut off locations. Deficiencies cited per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D. If not corrected, the violation with have a potential risk to the health, safety and/or personal rights of residents in care.

LPA requested the following documents to be submitted to CCL by 07/24/26: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) and a current copy of surety/liability insurance in order to update the facility file.

Exit interview was conducted with Administrator, Mariana. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided.