A Golden Horizon

Type of visit: Required - 1 Year

On February 3, 2026, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA was met by Hannah Gitau Caregiver and explained the purpose of the visit. The Administrator Lilian De Leon, subsequently joined to assist with inspection. The facility is licensed to serve (6) residents ages 60 and above. All rooms have fire clearance for bedridden residents. Approved hospice waiver for (6). Structure: This is a single-story home consisting of: four (4) resident bedrooms (Bedrooms #1, #2, #3 are single occupancy with full size beds Bedroom #4 is a shared room), one (1) staff room, two (2) bathrooms, one (1) living room, one (1) kitchen with dining area, outdoor shaded patio located in the back yard area, an attached garage along with washer and dryer located outside the garage. The front yard has adequate shaded area with seating and has an enclosed fence. Page 1 of 3 Physical Plant: LPA toured the physical plant with Caregiver, S1. There are no bodies of water or obstructions on the premises. A total of four (4) rooms were inspected. Bedrooms: LPA inspected all 4 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathrooms: Toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries are accessible to residents. LPA tested hot water temperature, and it measured between 105- and 120-degrees Fahrenheit. This facility provides residents with hygiene products such as feminine napkins, non-medicated soap, toilet paper, toothbrush, toothpaste, and comb. Required Postings: LPA observed all required documents posted throughout the facility. The facility has a working landline telephone. Page 2 of 3 Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked cabinet in the kitchen and are inaccessible to residents. LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Safety LPA observed 1 fully charged fire extinguishers. The last emergency drill was conducted on 12/8/25. Smoke detectors test and was operable File Review: LPA reviewed 3 resident files and found that 3 out of 3 had the required documents. LPA reviewed 3 staff files and found that 2 out 3 had the required documents, training, and certifications. LPA observed that 1 out 3 records not available for review. Medications LPA observed all centrally stored medications secured All medications were observed in their original packaging. LPA reviewed a copy of the facility’s Liability Insurance with expiration date of 1/27/27 Infection Control LPA observed required infection control signs posted throughout the facility. LPA observed sanitizing stations throughout the facility. LPA observed an ample supply of cleaning supplies Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Facility maintains documentation of the required emergency drills. During today’s visit there were no deficiencies cited. 1 Technical Violation issued. An exit interview was conducted with Administrator Lilian De Leon Page 3 of 3the state’s words, verbatim · CDSS document, Feb 3, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 01/16/2025, The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted an unannounced annual required visit using the CARE Inspection Tool. CCLD staff met with staff one, Hannah Gitau Caregiver (S1) and CCLD staff explained the purpose of the visit. The facility is licensed to serve (6) residents ages 60 and above. All rooms have fire clearance for bedridden residents. Approved hospice waiver for (6). This is a single-story home consisting of: four (4) resident bedrooms (Bedrooms #1, #2, #3 are single occupancy with full size beds Bedroom #4 is a shared room), one (1) staff room, two (2) bathrooms, one (1) living room, one (1) kitchen with dining area, outdoor shaded patio located in the back yard area, an attached garage along with washer and dryer located outside the garage. The front yard has adequate shaded area with seating and has an enclosed fence. CCLD toured the physical plant with Caregiver, S1. There are no bodies of water or obstructions on the premises. A total of four (4) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathroom #1 was measured at 117.1°F and Bathroom #2 was measured at 110.1°F, all water sources in the house were observed to be fully operational, without mold, and within Title 22 regulations. CCLD inspected the smoke detectors and determined they were in operable condition. Carbon monoxide / smoke detector combo was located in the garage, above the entrance to the garage from the staff room, and was not in operational condition. Please see LIC809-D. Evaluation Report Continues, see LIC 809-C. CCLD staff observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharp objects were observed and not accessible to residents. The kitchen was inspected and there is sufficient 2-days perishable and 7-days non-perishable food available, on-site, and the food(s) were properly stored. All fire extinguishers were charged and were operable. A review of (3) residents' service files and (3) Medication Administration Records (MAR) was conducted. All three (3) residents have not visited their physician since the year of 2022 and all three (3) residents have been marked as having "Mild Cognitive Impairment" (MCI). CCLD has requested that all four (4) residents have an updated physician's report from the year of 2025, please see LIC809-D. One error was noted in the MAR for one resident (R1). S1 confirmed the medication (M1) has been provided to R1 three (3) times (3x) per day. R1 confirmed with CCLD that they receive M1 3x per day. CCLD cited this deficiency as a technical violation, please see LIC9102-TV. One resident's (R2) documents were unable to be located, please see LIC809-D. All staff paperwork was not available to be reviewed, please see LIC809-D. CCLD reviewed first-aid kit, and was observed to be fully stocked. . LPA observed the facility's infection control practices, which has met CCLD requirements. A copy of the liability insurance was not provided, please see LIC809-D. Four (4) deficiencies have been cited during today's visit, please see LIC809-D. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), CCLD observed four (4) deficiencies during today's visit, please see LIC809-D. An exit interview was conducted with caregiver, Hannah Gitau (S1). A copy of the appeal rights, this facility evaluation report and four (4) deficiencies were provided.the state’s words, verbatim · CDSS document, Jan 16, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Annual/Random

On 1/3/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Lilian de Leon/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) residents ages 60 and above. All rooms fired cleared for bedridden. Approved hospice waiver for (6). This is a single-story home consisting of: (4) resident bedrooms, (1) staff room, (2) full bathrooms, living room, kitchen with dining area, outdoor shaded patio, backyard area, an attached garage with a washer and dryer located outside the garage. The front yard has adequate seating and has an enclosed fenced. LPA Iniguez toured the physical plant with administrator. There were no bodies of water or obstructions on the premises. A total of (5) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected the carbon monoxide detectors combo were in operable conditions. The water temperature properly measured between 105°-120°F: Kitchen 109.7°F, Bathroom #1:105.7°F, Bathroom #2:109°F. Evaluation Report Continues LIC 809-C LPA Iniguez observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. A review of (3) residents' service files, (3) staff personnel files and (3) Medication Administration Records (MAR). First AID kit was checked. Technical Advice given to administrator regarding quarterly disaster drills. LPA observed the facility's infection control practices. A copy of the liability insurance was provided to LPA during visit. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Lilian de Leon /Administrator.the state’s words, verbatim · CDSS document, Jan 3, 2024