Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual required – 1 yr. inspection on 05/22/2026 and met with Administrator, Stanford Madriaga. There are 3 residents living in the home. There were 2 caregivers present at the time of inspection.

LPA toured the facility and found it to be clean and at a comfortable temperature with all exits free from obstruction. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food in the kitchen refrigerator was properly stored and dated. Toxins are stored in closet in the locked laundry room. There was a supply of hygiene products and paper products available for residents. Facility is equipped with auditory alarms at all exit doors, and on the gates in the back yard. Bathrooms were equipped with necessary grab bars, non-slip floors/mats and paper towels. All bedrooms have lighting & appropriate furnishings, including plenty of linens. Resident rooms were clean and well-lit and residents were clean, appropriately dressed and satisfied with their care. The facility had one fire extinguisher, fully charged and last serviced on 06/17/2025. Last fire drill was on March 18, 2026 . There were 3 carbon monoxide/smoke detectors located in the hallways which were operational at the time of inspection. There were 6 smoke detectors in bedrooms, which were tested and operational.

LPA and Licensee reviewed the Emergency Disaster Plan for the facility and found it to be current. Licensee will update the Infection Control Plan and submit to LPA for review. In addition LPA requested an LIC 500 and proof of liability insurance.

Three (3) Resident and two (2) staff files were reviewed and found to be complete. Staff have required First Aid/CPR certificates, and all required annual training.

No deficiencies found at the time of inspection. No citations issued.

Exit interview conducted with Administrator, Stanford Madriaga.