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Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Christian Gutierrez conducted an unannounced required annual visit. LPA met with Caregiver, Griselda Orozco and explained the reason for the visit. Administrator, Maria Tavarez, arrived shortly and assisted with the visit. The facility is licensed to serve 4 non-ambulatory developmentally disabled elderly residents ages (60) and above. Hospice Waiver for (2) residents in place. The facility is operating within the scope of its license. Residents receive services through the Harbor Regional Center. The facility is a single-story house located in the city of Lakewood which consists of living room, dining area, kitchen, (4) resident bedrooms, (2) bathrooms, office area, activity room, laundry area in the garage, backyard/outdoor patio, and attached garage. LPA toured the facility and observed the following: Each resident’s bedroom has the required bedding and furniture. There is extra clean linen and towels in hallway closet. Smoke detectors and carbon monoxide detectors were observed in each room and throughout the facility and are properly operating. The facility has one (1) fully charged fire extinguishers. Cleaning supplies, toxic substances, and sharps are inaccessible to clients in a locked cabinet under kitchen sink. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are cleaning supplies, hygiene products, and emergency food in garage. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. SEE LIC 809C Three (3) out of four (4) staff files were reviewed and included Criminal clearance record, CPR/training, and health screening with TB. One staff was missing annual training and chest x-ray for positive TB test. Four (4) residents files were reviewed and included physicians report, TB clearance, and individual program plan (IPP)report. Last fire/earthquake drill was conducted in May of 2026. Infectious control plan was reviewed. Four (4) resident medications were reviewed. Medications are centrally stored and locked MAR log is used. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during today’s visit will be documented on LIC809-D. Exit interview was held and a copy of the report with appeal rights was given.the state’s words, verbatim · CDSS document, May 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced required annual visit. LPA met with Kevin Rodriguez, Caregiver, and explained the reason for the visit. Assistant Administrator, Maria Tavarez, arrived thereafter and assisted with the visit. Ricardo Banos, Administrator, was contacted telephonically and was also informed regarding the reason for the visit. The facility is licensed to serve 4 non-ambulatory developmentally disabled elderly residents ages (60) and above. Hospice Waiver for (2) residents in place. The facility is operating within the scope of its license. Residents receive services through the Harbor Regional Center. The facility is in a residential area of Lakewood, CA. During the visit, LPA toured the facility's indoor and outdoor environment and reviewed (4) resident and (3) staff files. Resident medication was also reviewed The facility is a single-story house which consists of: living room, dining area, kitchen, (4) resident bedrooms, (2) bathrooms, office area, activity room, laundry area in the garage, backyard/outdoor patio, and attached garage. During today’s visit, LPA observed the following: Facility was observed to be clean and maintained. Walkways around perimeter of facility are clear of obstructions. Living room furniture is clean and in good repair. There is sufficient seating for residents in care. Fire place was observed to be covered and inaccessible to residents. ****Continues on LIC 809-C Sufficient supply of 2 day perishable and 7 day non-perishable food was observed. Food is labeled and kept within expiration limits. Pantry was observed stocked and dry food transferred to "Easy Pour" containers is dated and identified by its content. Current menu observed posted in the kitchen. Sufficient resh fruit observed in the dining area. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and mattress pads. There is a closet in the hallway with extra clean linen, towels, and personal hygiene items for clients. Resident bedrooms are equipped with motion sensors connected to a main dock for staff to monitor. Two full bathrooms were inspected and were observed clean and sanitary. Showers have grab bars and anti-slip mats. The water temperature was tested in both bathrooms and measured within the required 105 - 120 degrees F. Interconnected, combination smoke/carbon monoxide detectors were observed throughout the facility and were tested and observed to be working properly. There is one fire extinguisher located in the kitchen which was observed to be charged. Lasts fire extinguisher inspection was conducted on 3/5/25. Drills are conduced monthly. Last fire/safety drill was conducted on 6/1/25/25. Sufficient supply of 2 day perishable and 7 day non-perishable food was observed. Food is labeled and kept within expiration limits. Current menu is posted in the kitchen. Sufficient fresh fruit observed in the dining area. Pantry was observed and "Easy Pour" containers were dated and labeled to identify contents. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Beds have the required linen and mattress pads. There is a closet in the hallway with extra clean linen, towels, and personal hygiene items for residents. Bedrooms are equipped with motion sensors which were tested and working properly. Two full bathrooms were inspected and were observed clean and sanitary. Showers have grab bars and anti-slip mats in place. The water temperature was tested in both bathrooms and measured 111.3 degrees within the required 105 - 120 degrees F. Interconnected, combination smoke/carbon monoxide detectors were observed throughout the facility and were tested and observed to be working properly. There is one fire extinguisher located in the kitchen which was observed to be charged. Lasts fire extinguisher inspection was conducted on 3/25/25. Drills are conduced monthly. Last fire/safety drill was conducted on 6/1/25. Doors leading out of the facility are equipped with alert chimes which were tested and working properly. The front and backyard are well maintained and there are no pools or large bodies of water. There is a seating area accessible to residents, located in the backyard patio. Patio umbrella is used for shade. Patio furniture is in good repair and there is enough seating for residents. Garage was observed clean and free of clutter. Laundry area is located in the garage. Detergents are kept locked and inaccessible to residents. Washer and dryer were observed in good repair and working during visit. Ramps, passageways and exits are free of obstruction. ****Continues on LIC 809-C Medication is centrally stored and locked in cabinet. Resident medication was reviewed and observed to be dispensed and documented accordingly. Four (4) resident and (3) staff files were reviewed and contained relevant documentation. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies are cited today. Exit interview conducted with Maria Tavarez, Assistant Administrator and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with Maria Tavarez (Administrator) and explained the reason for the visit. The facility is licensed to serve four (4) non-ambulatory, developmentally disabled elderly residents ages 60 and above. Facility is approved for hospice waiver for two residents. One of the residents is currently at a rehabilitation hospital. A tour of the single-story facility included: living room, kitchen, dining area, 4 resident bedrooms, family room, 2 bathrooms, front yard, backyard and attached garage. LPA and Maria Tavarez toured the facility and the following was observed: the front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 113.1 degrees F and 111.8 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen in each resident bedroom’s closet and clean towels in a hallway closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. There is one carbon monoxide in the hallway and is properly operating. There is a fire extinguisher in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps, cleaning supplies and toxins are kept locked under the kitchen sink and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. First Aid kit was fully stocked with current manual and it is kept locked in a hallway cabinet. Facility has a screen on the fireplace. The facility has a video camera surveillance system in all common areas and hallway. All residents signed the video camera surveillance system plan of operation and there was signs posted throughout the facility indicating video camera in use. Residents medication are centrally stored in a locked cabinet in the living room. Residents and staff files are centrally stored in the medication cabinet. (Continued to LIC 809-C) LPA reviewed medication for all 2 of the residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 2 residents and 4 staff and observed no issues with the files. LPA observed administrator certificate for Maria D Tavarez – 6028010740 with an expiration date of 08/25/2025. LPA reviewed P&I funds for all 2 residents with a staff present. Facility has a liability insurance and a surety bond on file. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report were provided.the state’s words, verbatim · CDSS document, Jun 20, 2024