B. Ruiz Carehome 2

Type of visit: Required - 1 Year

On 04/09/2025 at 10:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Zsymond Gregorio, Caregiver and explained the purpose of the visit. Zsymond called the Administrator to advise of visit. Jamie Ruiz, Administrator arrived at 11:41AM. LPA explained purpose of visit. Administrator currently holds a certificate (#7035384740) that expires on 10/04/2027. Facility has census of 6. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPA did not observe any bodies of water. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 113.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Continue on LIC809C.... Continued from LIC809 Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 04/13/2026. Emergency Disaster Plan was last posted on 03/10/2026. First aid kit was observed to be complete. Fire drill was last conducted on 03/06/2026. LPA reviewed six (6) resident records, and six (6) staff records, and they were current and complete. LPA also reviewed a sample of medication. LPA requested the following documents to be submitted to CCLD by 05/24/2026. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance No deficiencies were cited during visit. Exit interview conducted, A copy of this report provided to Jamie Ruizthe state’s words, verbatim · CDSS document, May 14, 2026

Type of visit: Required - 1 Year

On 04/09/2025 at 9:45AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Thelma Hababag, Direct Care Staff and explained the purpose of the visit. Thelma called the Administrator who arrived to the facility at 10:33AM. Administrator currently holds a certificate (#7035384740) that expires on 10/04/2025. Facility has census of 5. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPA did not observe any bodies of water. A comfortable temperature is maintained at 69 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 111.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 12/17/2024. Emergency Disaster Plan was last posted on 01/17/2025. First aid kit was observed to be complete. Fire drill was last conducted on 01/30/2025. Continued on LIC809C. Continued from LIC809. LPA reviewed five (5) resident records, and five (5) staff records, and they were current and complete. LPA also reviewed a sample of medication during visit. LPA requested the following documents to be submitted to CCLD by 04/16/2025. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance LPA observed the following deficiency: At 11:35AM LPA observed during file review, facility did not have a dementia care plan as part of the facility's plan of operations. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Required - 1 Year

On 04/24/2024 at 12:40PM, Licensing Program Analysts (LPAs) T. Syess-Gibson and C. Fowler conducted an unannounced 1-Year Required inspection. LPAs met with House manager Marilou Intog, and explained the purpose of the visit. Marilou called the Administrator who arrived to the facility at 3:04PM. Administrator currently holds a certificate (#7035384740) that expires on 10/04/2025. Facility has census of 6. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPAs toured the facility with House Manger including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPAs did not observe any bodies of water. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 113.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 007/19/2023. Emergency Disaster Plan was last posted on 11/03/2023. First aid kit was observed to be complete. Fire drill was last conducted on 03/16/2022. Four (4) staff records were reviewed. During record review . LPA reviewed three (3) resident records, and they were current and complete. Continued on LIC809C. Continued from LIC809. LPAs requested the following documents to be submitted to CCLD by 05/01/2024. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPAs observed the following deficiencies: At 12:55pm LPAs observed medications in an unlocked cabinet in kitchen At 1:00pm LPAs observed disinfectants in unlocked cabinet under kitchen sink At 1:15pm LPAs observed bleach, fabuloso, comet and Lysol spray under the unlocked sink cabinet in the common bathroom At 1:18pm LPAs observed a room with a bed and clothing in closet in common bathroom At 1:25pm LPAs observed a lawn mower, area rug, and exercise equipment near emergency exit gate Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 24, 2024