JLC

Type of visit: Required - 1 Year

On 3/07/26, 10:45 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced annual facility visit. LPA met with Facility Administrator, and reason for the visit was discussed. Facility is licensed as a single-story residence. Fire clearance approved for four (4) Non-ambulatory residents. Hospice waiver for three (3) residents. Facility has two (2) shared bedrooms, and one (1) bathroom. Purpose of today’s visit was to inspect and ensure that facility maintains compliance under California Code of Regulations, Title 22, Division 6. At 11:15 am, LPA conducted a tour of physical plant with the Administrator and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Visitor sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 74.0°F., within the required range. Mitigation and Infection Control plan is on file. Hand washing, coughing etiquette, and other necessary signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted on 2/15/26. Fire Detection/Protection system is present in the facility. Dual Smoke and Carbon Monoxide detectors were tested and function properly. LPA observed a fire extinguisher located in the hallway near bedroom #1. Extinguisher displays service date: 2/06/2026. [LIC 809-C Continued] Kitchen: At 11:40 AM, LPA observed kitchen as clean, equipped with a functional stove, refrigerator, multiple appliances, microwave, oven, and sink. LPA observed supply of two (2) days perishable foods and a seven (7) day supply of nonperishable food sufficient for residents. Knives and sharps were observed as secured and locked in lower level kitchen cabinet. Laundry room area is located adjacent to the kitchen. Laundry soaps and other cleaning agents are stored in locked lower cabinet under the kitchen sink. Hallway area storage cabinets contain incontinent supplies, linens, and towels. Commons: LPA observed living room and dining area equipped with sofa, television, table and chairs; common areas observed as clean and organized. Furniture is in good condition providing adequate seating for residents. Living room area dresser contains arts and crafts, board games, puzzles, and other activities for resident use. Bedrooms: LPA observed two (2) shared bedrooms. Bedrooms are clean, well lit, and properly furnished with televisions, closed lid trash cans, sufficient closet space, bedding, linens, chairs, and night stand. Bathrooms: Facility has one (1) bathroom, which was observed to be clean and sanitary, with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 117°F. Within the required range. Towels and washcloths are not shared. Medications LPA observed a secured medication cart, located in kitchen area. Medications are listed on a centrally stored medication and destruction record log. First aid kit was fully stocked and manual was observed. Outdoor At 12:05 PM, LPA observed (backyard) area with shaded patio, table, and sufficient seating for residents. Outdoor furniture observed to be in good condition. A locked shed in the backyard stores tools, maintenance supplies, and PPE. All trash cans were observed to be covered. There are no bodies of water in the facility. [LIC809C]-Continued- Resident records: Medication cart's lower drawer contained records which were observed as locked and inaccessible to residents. A total of four (4) resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Records were observed as current and complete. Staff records: Medication cart's lower drawer contained records which were observed as locked and inaccessible to residents. Criminal record clearances were present, and staff are associated to this facility. All required records were observed as current and complete. There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was provide to the Administrator.the state’s words, verbatim · CDSS document, Mar 7, 2026

Type of visit: Prelicensing

On 3/06/25, 9:25 AM, Licensing Program Analyst, (LPA) Raymond Comer, conducted an announced Pre-Licensing Inspection with Administrator, Jocelyn Espiritu. An application to operate an Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) in August, 2024. A fire clearance was approved on 9/20/2024, for four (4) non-ambulatory residents; total capacity of four (4). The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6. At 9:40 AM, LPA conducted a tour of the physical plant with the Administrator and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Visitor sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 72.0°F., within the required range. Fire Detection/Protection system is present in the facility. Dual Smoke and Carbon monoxide detectors are hard wired, inter-connected; alarms were tested and function properly. LPA observed a fire extinguisher located in the hallway near bedroom #2. Extinguisher displays service date: 11/01/2024. Medications will be stored in a secured, locking medications cart located in the kitchen area. First aid kit and manual are stored in a locked tool kit box, located in the hallway closet, and is equipped with necessary supplies. [LIC809C-Continued] Kitchen: At 10:20 AM, LPA observed kitchen as clean, equipped with a functional stove, refrigerator, multiple appliances, microwave, oven, and sink. There will be an adequate supply of two (2) days perishable foods once residents are admitted to the facility. LPA observed a seven (7) day supply of nonperishable foods to accommodate a maximum capacity of four (4). Knives and sharps were observed as secured and locked in lower level kitchen cabinet. Laundry room area is located adjacent to the kitchen. Laundry soaps and other cleaning agents are stored in locked lower cabinet under the kitchen sink. Hallway area storage cabinets contain incontinent supplies, linens, towels, and linens. Commons: LPA observed living room and dining areas equipped with sofa, television, table and chairs; common areas observed as clean and organized. Furniture is in good condition and provides adequate seating for residents. Living room area dresser contains arts and crafts, board games, puzzles, and other activities for resident use. Bedrooms: LPA observed two (2) shared bedrooms designated for residents. Bedrooms are clean, well lit, and properly furnished with televisions, closed lid trash cans, sufficient closet space, bedding, linens, chairs, and night stand. Bathrooms: Facility has one (1) bathroom, which was observed to be clean and sanitary, with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 116.5°F. Within the required range. Outdoor At 10:45 AM, LPA observed (backyard) area as having a shaded patio, table, with sufficient seating for residents. Outdoor furniture observed to be in good condition. A locked shed in the backyard stores tools, maintenance supplies, and PPE. All trash cans were observed to be covered. There are no bodies of water in the facility. Resident records: Resident records will be stored in a secured, locking medications cart, located in the kitchen area. Staff records: Staff records will be stored in a secured, locking medications cart, located in the kitchen area. There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was provide to the Administrator.the state’s words, verbatim · CDSS document, Mar 6, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 4 Interview Method: Telephone interview On 2/7/2025, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 7, 2025