The facility is licensed to serve residents ages sixty (60) and older. The approved capacity is six (6) non-ambulatory residents. The facility has an approved hospice waiver for six (6).

Facility Tour & Observations

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Oxygen was observed in use in the facility. Required “Oxygen in Use / No Smoking” signs were posted throughout the facility in visible locations. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Physical Plant

“The facility is located in a residential area and is a single-story home consisting of three (3) resident bedrooms; two (2) restrooms, including one private resident restroom; a living room/dining area; kitchen; laundry room/garage; front yard; and backyard. The facility also includes two (2) offices located within the garage. LPA observed three (3) resident bedrooms, all of which contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. Cleaning supplies and toxic substances were secured in the garage and inaccessible to residents. Bathrooms were clean and equipped with required grab bars in the showers and near toilets, as well as non-skid mats. Hot water temperature measured 114.2°F in bathroom (1) and 116.9°F in bathroom (2), which are within the required range of 105–120°F. Additional linens and towels were available in a hallway cabinet. Smoke and carbon monoxide detectors were operational, and a fully charged fire extinguisher was available in the kitchen/dining area. The backyard provided shaded seating for residents. All passageways and exits were observed to be clear and unobstructed.

(continued on 809C)

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer.

Health-Related Services & Records

Four (4) resident files were reviewed and contained current required documents, including Admission Agreements, Pre-Placement Appraisals, consents, Physician’s Reports with TB/ambulatory status, and Rights acknowledgments. Three (3) residents’ medications were reviewed and were centrally stored in a cabinet near the kitchen.

Disaster Preparedness

Logs of fire and earthquake drills was reviewed and confirmed to be conducted quarterly. The LIC 610D Emergency Disaster Plan was observed to be posted on the entry bulletin board. Emergency supplies, including water, food, flashlights, batteries, and a first aid kit, were observed in the garage. The Infection Control Plan was reviewed and found to be current.

Personnel Records & Training

Three (3) staff files were reviewed and included criminal record clearances, CPR/First Aid, required trainings and TB screenings. Administrator Certificate for Michelle Aguirre August 28, 2026.

Insurance

Liability insurance was in compliance with an expiration date of June 15, 2026.

An exit interview was conducted with Venus Calzado, Caregiver.During the inspection, the facility was observed to be following Title 22, Division 6 regulations. No deficiencies were cited at this time. A copy of the report was provided.