Forever Young Again

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Luis De Leon conducted an unannounced required annual inspection visit. LPA met with Administrator Joni Ramos and explained the reason for the visit. The facility is licensed to serve four (4) residents for 60 years and over. The facility is approved for four (4) non-ambulatory residents, of which one (1) may be bedridden. The facility is approved for four (4) hospice waivers. The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: FACILITY PHYSICAL PLANT The facility is in a residential area and is made up of two (2) resident bedrooms, one (1) full bathroom and one (1) half-bathroom for residents’ use, kitchen, laundry located near backdoor, dining room, living room, front and backyard. There were no body of water observed in the property. REVIEW OF FILES LPA reviewed three (3) out of three (3) Resident files which consisted of Admission Agreements, Identification and Emergency Info, Physicians Report, Consent Report, Needs and Service Plan, Personal Rights, and Centrally Store Medication. LPA reviewed four (4) staff files which consisted of Personnel Report, Health Screening, Criminal Record Statements, Fingerprint Clearance, Training, First Aid and CPR. Emergency and Disaster Plan, Infection Control Plan, and Liability Insurance. (Report continues report LIC-809C...) Observations during facility tour: Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPA observed that there were clean linen, bath towels, and personal hygiene with reasonable closet space available for clients. Wall and floors are in good repair. Hallways were clean and free of obstructions. Windows screens were clean and free of debris. Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable food. Dining room has sufficient seating area. Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean. The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees. Sharps are locked outside main house in storage in the back yard. Disinfectants and cleaning supplies are locked and secured in backyard shed inaccessible to clients. Smoke detectors were observed in all bedrooms and carbon monoxide detectors were observed in living room around kitchen area. One (1) fire extinguisher was observed and was fully charged with last inspection on 05/27/2026. Last fire drill and disaster drill were conducted on 07/01/2026. Earthquake drill was done on 04/01/2026. Front and back yards are free of hazards. Back yard has a shaded seating area for clients to enjoy. The medications are centrally stored and locked in the staff room. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all three (3) residents. LPA conducted interviews with one staff and one resident. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit interview was held and a copy of the report was provided to the Administrator Joni Ramos.the state’s words, verbatim · CDSS document, Aug 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Luis De Leon conducted an unannounced required annual inspection visit. LPA met with Administrator Joni Ramos and explained the reason for the visit. The facility is licensed to serve four (4) residents for 60 years and over. The facility is approved for four (4) non-ambulatory residents, of which one (1) may be bedridden. The facility is approved for four (4) hospice waivers. LPA uses the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. LPA De Leon toured the facility with assistance of administrator Ramos: FACILITY PHYSICAL PLANT The facility is in a residential area and is made up of two (2) resident bedrooms, one (1) full bathroom and one (1) half-bathroom for residents’ use, kitchen, laundry located near backdoor, dining room, living room, front and backyard. There were no body of water observed in the property. REVIEW OF FILES LPA reviewed four (4) out of four (4) Resident files which consisted of Admission Agreements, Identification and Emergency Info, Physicians Report, Consent Report, Individual Program Plan, Personal Rights, and Centrally Store Medication. LPA reviewed four (4) staff files which consisted of Personnel Report, Health Screening, Criminal Record Statements, Fingerprint Clearance, Training, First Aid and CPR. Emergency Disaster Preparedness, Operation Plan, Hospice and Dementia care plans. Report continues on report LIC-809C... All resident rooms were inspected, and LPA observed resident beds, dressers, and chairs in good repair. Adequate linen and personal hygiene supplies are observed with enough closet space for resident’s personal belongings. Sufficient space to accommodate both indoor and outdoor activities was observed. The administrator stated that residents participate in board games, reading, and community walks. Walls and floors are in good repair. Common areas are observed for the ability to safely serve the needs of the residents without obstruction. Smoke detectors and carbon monoxide detectors were tested and operational in resident’s rooms and common areas. Facility temperature was comfortable, 71 degrees F. The bathrooms are clean and operational. The hot water temperature was tested in the residents’ bathrooms and was within the required range of 105-120 degrees F. Showers were free of mold/mildew, had adequate lighting, and there are sufficient toiletries that are accessible to residents. The last fire and earthquake drill was done on 6/24/25. One (1) Fire extinguisher is fully charged, last serviced on 5/30/25. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Sharps are locked inside the cabinet next to the refrigerator and are inaccessible to residents. Cleaning supplies and grooming supplies were observed locked in an exterior cabinet. The backyard and front yard are clean, free of debris. No large bodies of water were observed. Facility provides telephone landline and internet for the residents. There is sufficient staff at the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Staff have sufficient on-going training that meets the annual requirement. The medications are centrally stored and in their original containers. LPA reviewed four (4) out of four (4) residents’ medications. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today’s visit. Exit interview was held and a copy of the report was given to Administrator Joni Ramos.the state’s words, verbatim · CDSS document, Aug 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alma Gonzalez conducted an annual inspection visit. LPA was allowed entry by Administrator Martiniana Laureta. LPA discussed the purpose of today’s visit. . The facility is licensed to serve 4 non-ambulatory elderly residents age 59 and over. Approved for (4) Non Ambulatory of which 1 may be bedridden. Approved Hospice Waiver for 4. Currently, there are five (4) residents placement. The facility consists of : 2 resident bedrooms, 2 bathrooms (1 staff bathroom), kitchen/ dining, living room and yard area. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility does has an Infection Control Plan in place. Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. The furniture in the dining room was adequate and the kitchen was clean. The appliances were working properly. The refrigerators and freezer are set at appropriate temperatures. LPA toured resident rooms which were randomly chosen for inspection on both floors. There are smoke detectors and fire extinguishers located throughout the building. The hallways and stairways are clear and free of any obstructions. Resident rooms were observed to be clean, properly furnished and have the required linen which were in good condition. There was adequate lighting throughout the facility. All resident rooms had appropriate storage for resident's personal belongings. The **Continued on LIC809C** bathrooms have the required grab bars near the toilet and in the shower. Showers also have non-skid materials. The hot water was tested and was between in random resident rooms and was at 115 degrees, which is within Title 22 regulations. Restrooms were observed to be clean, and operational. There is no pool or large bodies of water on the premises. A comfortable temperature was maintained throughout the facility. Staffing: Facility is adhering to staffing requirements. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator and Staff 1-2 (S1-2). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Resident Rights-Information: Resident rights are posted and included in Resident files. Planned Activities: Activity schedule is posted. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Posted menu observed. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed Resident files for Resident 1-4 (R1-4). Resident files are maintained at the facility. Resident files have the required documents. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. Residents with Special Health Needs: Per Administrator, there are no residents with postural supports and no residents with prohibited health conditions. Per Administrator, there are (0) residents utilizing oxygen equipment. Health Related Services/Incidental Medical Services: The medications are stored/ locked inside the medication room and are inaccessible to residents. Exit interview conducted, and a copy of this report was provided to Administrator Martiniana Laureta.the state’s words, verbatim · CDSS document, Jul 30, 2024