Young at Heart RCFE No.1

Type of visit: Case Management - Annual Continuation

On September 3, 2026, at 12:30 PM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct an annual required inspection. LPA Lopez met with Administrator (A1) Glenda Molinyawe and explained the purpose of today's visit. The facility is licensed for (5) non-ambulatory residents and (1) bedridden resident. There are currently (6) residents who reside at this facility. The facility has an approved hospice waiver for (2). At 12:50PM, LPA Lopez conducted a records review of (4) staff and (3) resident files. Client and resident files were maintained current and contained the required components. Facility staff records indicated ongoing training is being conducted regularly. LPA Lopez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; facility bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. At 1:30 PM, LPA Lopez toured the physical plant with A1 including but not limited to the kitchen, dining room, resident bedrooms, facility bathrooms, laundry room, and backyard of the facility to ensure compliance with Title 22 regulations. The facility was clean, safe, and in good repair. The facility temperature was 72 degrees. The facility’s fire extinguishers were last inspected on November 2025. The facility carbon monoxide and fire alarms are located on the ceilings and observed to be in working order. Continued on LIC 809-C. The exterior of facility was clear of debris. The facility had a shaded seating area in the front of the home and also in the backyard. The patio area is furnished with outdoor furniture. The facility’s toilets, hand washing, and bathing areas were sanitary and operational. All showers had non-slip mats and grab bars to ensure safety. The residents’ bedrooms were in good repair, and furnished with a chair, dresser, lighting, bed, and night stand table. Bedroom window and screen were both in good repair. The resident’s bedrooms had clean linen. Medications were stored in a locked cabinet. The facility uses a MAR sheet to record all dispensed medication to residents. LPA requested the following documents to be emailed or faxed to the Regional Office within 15 days: - LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan As a result of this annual inspection visit, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was held, and a copy of this report was given to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Sep 3, 2026

Allegation investigated: Staff did not ensure emergency paperwork went with the resident to medical appointment Staff did not notice residents change in condition requiring hospitalization

On 05/07/2026, Licensing Program Analyst (LPA) Pang Lee conducted an unannounced facility visit to initiate and close a complaint investigation. LPA Lee met with Administrator Glenda Molinyawe. The facility census were five residents with two staff present at the time of the visit. It was alleged that staff did not ensure emergency paperwork went with the resident to a medical appointment and that staff did not notice a resident’s change in condition requiring hospitalization. The investigation consisted of record reviews and interviews with Administrator Molinyawe. During the investigation, it was learned that Resident 1 (R1) did not reside at Young at Heart RCFE No. 1, Inc., but instead resided at Young at Heart RCFE No. 2, Inc. The Department has investigated the complaint allegations listed above and determined the complaint to be UNFOUNDED, meaning the allegations were false, could not have happened, and/or was without reasonable basis. Therefore, the complaint has been dismissed. No deficiencies were observed or cited during today’s complaint visit. An exit interview was conducted. Unfoundedthe state’s words, verbatim · CDSS document, May 7, 2026 · control 27-AS-20260504084458

Allegation investigated: Staff did not conduct a proper pre-admissions appraisal for resident. Staff does not ensure resident is provided adequate care services. Staff is retaining a resident who requires a higher level of care.

On February 19, 2026, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to complete and close the investigation into an allegation noted above. LPA met with Administrator, Glenda Molinyawe (S2) and stated the purpose of this visit. This investigation focused on Resident2 (R2). Throughout the process, the LPA conducted facility observations, interviewed on duty staff and residents, collateral interviews, as well as reviewed relevant documents related to R2. Allegation: Staff did not conduct a proper pre-admissions appraisal for resident. It was alleged “Staff did not conduct a proper pre-admissions appraisal for resident”, the investigation included interviews with staff, residents, and three collateral witnesses, as well as review of records, and observations made on 12/12/2025. CONTINUED 9099-C2 Substantiated During a facility visit on 12/12/25, LPA observed R2’s records including their admission agreement, pre-admission appraisal, and Physicians report (LIC 602) were not available for department review. S1 stated the documents were completed but they were working on records off-site. S1 sent R2’s records to LPA on 2/17/25. Licensee, Lilian Sisyan (S1), stated they went in person to conduct an initial intake interview prior to resident moving in on 11/25/25. It was reported by W1 and W2 that S1 was provided with verification of R2’s needs and level of care prior to acceptance. On 12/12/25, it was learned that R2 moved into the facility on 11/25/25 and they had not been out of bed since move in date, due to the facility not having staff that was able to lift R2 nor a Hoyer Lift that could safely sustain R2’s weight. Since admission, staff confirmed they have been cleaning, bathing, providing meals and all care in bed, as they await a Hoyer lift for R2. R1’s pre-placement appraisal was completed on 11/11/25. S1 went out in person to meet with S1 one time prior to admission on 11/25/25. On 12/17/25, LPA reviewed a copy of a LIC 625 Appraisal dated 11/25/25. Although the appraisal states the residents’ known conditions. S1 states they were unaware of the extent of R2’s needs and behaviors until they moved in and R2's weight is not accurate on the intake paperwork. R2's actual weight has not been confirmed since move in however S1 observed it took four paramedics to transfer them. Moreover, R2’s wheelchair is not a standard sized wheel chair, as it is an extra large wheelchair. It was confirmed by S2 that the wheelchair does not fit through the interior door passageways, making it so R2 is not able to be transported for meal times in the common areas. Intake documents state R2 requests to be transferred onto their wheelchair for meal times, up to three times per day. S1 stated concerns around transferring R2 three times per day due to the level of pain they are under. LPA provided guidance on intake and admission regulations. Based on interviews and record review of the LPA and review of records the allegation, staff did not conduct a proper pre-admissions appraisal for resident is substantiated. Allegation: Staff does not ensure resident is provided adequate care services. It was alleged staff does not ensure resident is provided adequate care services, the investigation into the above allegation consisted of interviews and record reviews. Interviews with S1-S3, it was reported that at minimum residents are checked on about every two hours , or more often if needed. CONTINUED ON 9099-C3 S1 stated there there are at least two staff scheduled to care for up to six residents each shift and one wake staff at night time. On 12/12/25, 87468.1(a) Personal Rights of Residents in All Facilities was cited due to LPA’s observation of mobility devices not being accessible within reach for R2 and Resident 3 (R3) whom are non- ambulatory and require a mobility devices. The Plan of Correction (POC) was cleared by 12/16/25. Moreover, interviews with S1 confirms there was not a Hoyer lift in the facility that can sustain R1’s weight. S1 stated they have had a Hoyer lift that sustains 250 pounds but after observing it takes three paramedics to transfer R2, and a Hoyer lift with a higher weight capacity is needed to safely assist R2. On 2/19/25, S2 stated a Hoyer lift was obtianed December 2025 from another facility due to Master Care not assisting with obtaining the Hoyer lift. Staff did not ensure R2’s wheel chair fits thru the doorways prior to admission. Staff interviews and observations reveal that the wheelchair for R2 is too wide to fit thru all doors because it was an extra large wheelchair. On 12/12/25 and 2/19/26, LPA observed R2's wheelcahir is stored in the backyard. Based on interviews and record review of the LPA the allegation staff does not ensure resident is provided adequate care services is substantiated. Allegation: Staff is retaining a resident who requires a higher level of care. It was alleged “Staff is retaining a resident who requires a higher level of care”, the investigation into the above allegation consisted of interviews and record reviews. Interviews with S1-S3, it was reported that at minimum residents are checked on about every two hours , or more often if needed. Staff said they there are about 2-3 staff scheduled to care for 6 residents each shift. Staff interviews with S2 and S1 and observations corroborate staff did not ensure R2’s wheelchair fits thru the doorways prior to admission, this poses a safety and personal rights risk. Incident report dated 1/6/26, states R2 was sent out to the hospital due to a high level of pain. Per S2, R2 has been in the hospital from 1/6/26 to this day due to the type and dosage of pain medications that R2 is requesting. Per S2, R2 requested new placement and Sutter General Hospital are in the process of obtaining a new placement for R2. Based on interviews and record review of the LPA, the allegation staff is retaining a resident who requires a higher level of care, is substantiated. As a result, the allegations above are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was was conducted and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.the state’s words, verbatim · CDSS document, Feb 19, 2026 · control 27-AS-20251211102943

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(a)(2) · Plan of correction due date: Feb 27, 2026

87457 Pre-Admission Appraisal (a) Prior to admission, the prospective resident...shall be interviewed ... (2) The prospective resident's desires regarding admission, and his/her background, including any specific service needs, medical background and functional limitations ... This requirement is not met as evidenced by: Based on record review and interviews, staff did not ensure to there was a Hoyer lift that can sustain R2's weight prior to admission and R2's extra large wheelchair fits thru the doorways. This poses an immediate/potential risk to residents in care.the state’s words, verbatim · CDSS document, Feb 19, 2026

Plan of correction: By POC due date, licensee/Administrator shall submit a plan to ensure to review provide a statement of acknowledgement of review of 87457 along with an updated plan for pre-admission intake process.

From the deficiency page — Section cited: CCR 87464(d) · Plan of correction due date: Feb 20, 2026

87464 Basic Services (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal...either directly or through outside resources. Based on record review and interviews, staff did not ensure to there was a mobility devices available at time of admission to ensure they are able to transfer out of bed for ADL's and having meal times in common areas. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Feb 19, 2026

Plan of correction: By POC due date, licensee/Administrator shall submit a plan to ensure to review provide a statement of acknowledgement of review of 87457 along with a plan to update appraisal for all residents who have not had one in the last 12 months or have had a change in condition.

Type of visit: Case Management - Deficiencies

On 11/26/2025, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to this facility to conduct a case management visit for deficiencies observed on 12/12/2025. LPA met with Glenda Molinyawe and explained the purpose of this visit. LPA observed there was a hoyer lift and two mobility devices obstructing one of the sliding door exits, located by bedroom 6. LPA observed the top and bottom bed rails were lifted in R2's bed and they S2 stated they do not know if R2 has a physicians order for a full bed rail. Additionally, mobility devices were not available near R2 and R3 during this visit whom are non- ambulatory and require a mobility device. Moreover, R2 and S2 stated that R2 has only been in bed since move in date on 11/25/25, they are changed and recieve bed baths while in bed as there is no hoyer lift available that has the capacity to assists R2. LPA observed there is one hoyer lift at the facility. S2 stated the hoyer at the facility cannot sustain 300 plus pounds and the licensee is in contact with Master Care to get an safe and appropriate hoyer lift for R2. Resident records for R2 where not available for review by LPA during this visit. S2 stated R2 moved in on 11/25/25 and the licensee has the record with them. S2 stated they will e-mail R2's records to LPA by 12/15/25. As a result of this case management visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with (S2) and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Dec 12, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Dec 13, 2025

87307 Personal Accommodations and Services (d) ... safety provisions... (6) All outdoor and indoor passageways ... shall be kept free of obstruction, this requirement was not met as evidence by LPA observations and interviews in which LPA observed there was a hoyer lift and two mobility devices an exit passageway, this poses an immediate/potential health and safety risk for residents in carethe state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: LPA observed staff cleated the exit passageway during this visit. By 12/15/25, Facility staff will submit a statement of review and understanding of 87307(d)(6) and submit a plan to train al staff on fire clearance regulations.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a) · Plan of correction due date: Dec 13, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents ... personal rights: (2) To be accorded safe, healthful and comfortable accommodations ... and equipment. This requirement was not met as evidence by LPA observations, interviews, and record review in which it was the top and bottom bed rails were lifted in R2's bed and there was no physicians order available for review during this visit. Additionally, mobility devices were not available near R2 and R3 during this visit whom are non- ambulatory and require a mobility device. Moreover, R2 and S2 stated that R2 has only been in bed since move in date on 11/25/25. S2 stated there s not currently a hoyer that can up to 300 plus pounds at the facility the licensee is in contact with Master Care to get an safe and appropriate hoyer lift for R2. this poses an immediate/potential health and safety risk for residents in carethe state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: By POC due date, the facility will submit a plan for ensuring mobility devices are accessible to residents who require mobility devices, only residents with physicians orders for full bed rails can have full bed rails, and to ensure inaccessibility of mobility devices does not act as restraint for residents and resident personal rights are not being violated.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Dec 15, 2025

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. this requirement was not met as evidence by LPA observation, interview, and record reviews due to resident records for R2 where not readily available for review during this visit which poses an immediate/potential health and safety risk for residents in care including admission agreement, LIC 602, care plan, pre-appraisal, etc. this poses an immediate/potential health and safety risk for residents in carethe state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: By POC due date: Licensee will email LPA resident record for R1 by 12/15/25 and ensure current record is maintained for each resident in the facility from 12/15/25.

Allegation investigated: Staff do not meet a resident's incontinence needs Staff speak inappropriately towards a client Staff threatened a resident with eviction Staff are mishandling a resident's personal funds Staff does not provide daily activities for resident Staff do not assist resident with obtaining medical appointments

On 07/02/25, Licensing Program Analyst (LPA) Cynthia Tamayo conducted an unannounced facility visit to close a complaint investigation. LPA Tamayo met with administrator Glenda Molinyawe and explained the purpose of today's visit. The census is 6. During today’s visit, LPA Tamayo toured the facility with administrator Glenda Molinyawe and observed 5 residents in the facility. LPA Tamayo interviewed three residents (R1-R3). LPA reviewed The following documents pertaining to residents 1-6 (R1-R6): -- Current Resident Roster - LIC 601 Identification and Emergency - LIC 602 Physician’s Report -Posted Activity calendar (June) -Financial record keeping for R1 Continued LIC 9099 Unsubstantiated - Current LIC 500 Personnel Report -LIC 624 Incident reports -LIC 625 Needs and Service Plan -Incontinence Log -Progress or Case notes LPA Tamayo interviewed three residents who were able to respond verbally and coherently (R1, R2, and R3). R4-R5 were asleep during this visit and R4 was hospitalized/not present at the facility during this visit. Of these, two were not diagnosed with any sort of cognitive impairments (R1 and R2). R3 voiced no concerns with their quality of care, and said they receive all assistance when needed. R1 voiced no concerns with quality of care, and said that other residents are cared for appropriately by staff, such as ensuring that they are bathed and that their diapers are changed regularly. R1 stated they were off their medications when they made a complaint. R2 voiced no concerns with their quality of care and said they had their basic needs met and they receive assistance with other ADLs when requested. R1 stated staff is "very nice here" and helps them with Medical appointments, speak appropriately with residents. R2 stated staff has not treated eviction stating "I was just of my medications and yelling a lot". R1 stated they do activities such as reading the bible and playing disco. Staff is assisting R1 with rescheduling an eye appointment due to Doctor ending the video call during the last appointment as a result of inappropriate comments made by R1. R1 stated he is lonely and wants to talk to someone and wants a counselor. R1 has their next medical appointment scheduled for 7/15/2025 at 2:00PM with their primary care physician. Staff stated they socialize with R1 but will look into a counselor request and additional resources. R1 stated they know S1's phone number by memory and call them everyday to talk to them. The department has determined the following as it relates to the allegations that staff do not ensure residents' incontinence needs are met, speaking inappropriately towards a client, staff threatening a resident with eviction, mishandling a resident's personal funds, staff does not provide daily activities for resident, and assisting residents with obtaining medical appointments. Continued on 9099-C Based on interviews and observations, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiencies were cited regarding the above allegations. An exit interview was held and a copy of this report was left at the facility .the state’s words, verbatim · CDSS document, Jul 2, 2025 · control 27-AS-20250312152218

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Tamayo arrived at the facility unannounced for a required one-year visit. LPA arrived at 1:22 PM and met with facility Administrator Glenda Molinyawe (S2). Entrance interview conducted. Administrator Certificate # for Glenda Molinyawe is 6052178740. The facility is approved for up to 6 residents age 60 and over of which 5 may be non ambulatory and one bedridden with hospice waiver for 2. Beginning at 1:22PM, a tour of the physical plant was conducted with the Licensee to ensure residents’ health and safety and the facility is in compliance with Title 22 regulations. The following was observed: KITCHEN: Appliances and fixtures were clean and functional. The facility had ample supply of perishable and non-perishable food. Meals are prepared by the Staff. Refrigerator temperature was at 45 degrees F and freezer temperature was at 0 degrees F. Knives and other sharps are locked inaccessible in a drawer. Kitchen and house cleaning supplies are stored in a locked cabinet located under the sink. COMMON AREAS: Common areas include the Living Room and Dining Room. All furniture was observed to be clean and in good condition with enough seating for six residents . There was space to accommodate both indoor and outdoor activities. LPA noted an Activity Calendar and activity storage in the Entrance Bulletin Board. One (1) fire extinguisher was observed throughout the common area and was last serviced on 09/2025. Combination smoke detectors and carbon monoxide detectors were working and operational. Continued on 809-C EXTERIOR: Exterior passageways were clean and clear of any obstructions. There is a covered patio area for client and visitor use with furniture observed to be in good condition. Clients are supervised at all times when they are outside. There is one (1) gates with a self-latching mechanism for persons to exit the backyard in emergencies. BEDROOMS: LPA inspected facility bedrooms. The facility has six(6) total resident. Bedroom #1 is shared, Bedroom #2-5 are private and bedroom #6 is designated as private staff room. All bedrooms were observed to contain furniture, bedding and linens within regulation. Extra linens are stored in the hallway cabinet. Client bedrooms had no visible hazards or inconsistencies observed. Resident 4 (R4) in bedroom #1 is bed bound and on hospice. R4 recives oxygen and there is a posted "oxygen use" and "no smoking sign". BATHROOMS: There are three (3) bathrooms: one (1) is a resident bathroom attached to bedroom #1 and two bathrooms are in the hallway of which one (1) is a shared bathroom designated for residents and the other bathroom is designated for visitors and staff. All bathrooms were observed to be clean and sanitary, and supplied with paper and hygiene products. Water temperature was tested and both measured at 114 degrees F. MEDICATION REVIEW: LPA reviewed medications at 4:00 PM which are centrally stored in a locked cabinet in the hallway. Five(5) out of six (6) clients medications were reviewed. All medications were stored and administered in compliance with regulation. RECORD REVIEW: LPA reviewed six (6) resident file records. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Resident files reviewed contained all required documents. LPA reviewed three (3) staff records during today's visit. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All staff records reviewed were in compliance at the time of the visit. Continued on 809-C RESIDENT INTERVIEWS: LPA Tamayo interviewed three residents who were able to respond verbally and coherently (R1, R2, and R3). R4-R5 were asleep during this visit and R4 was hospitalized/not present at the facility during this visit. Of these, two were not diagnosed with any sort of cognitive impairments (R1 and R2). R3 voiced no concerns with their quality of care, and said they receive all assistance when needed. R1 voiced no concerns with quality of care, and said that other residents are cared for appropriately by staff, such as ensuring that they are bathed and that their diapers are changed regularly. R1 stated they were off their medications when they made a complaint. R2 voiced no concerns with their quality of care and said they had their basic needs met and they receive assistance with other ADLs when requested. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility's infection control plan as well as the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are within regulation. Both documents were observed to be complete and recently updated. Personal Protection Equipment (PPE) and extra emergency supplies, including emergency food and water, are stored in the garage. The following documents will be email to LPA by 7/11/25 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) Surety Bond (7) LIC 309 Administrator Organization As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Glenda Molinyawe, and a copy of these LIC 809 reports were provided to the facility.the state’s words, verbatim · CDSS document, Jul 2, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 1/13/25 at 3:45p to conduct a Case Management visit. LPA obtained information that a resident was possibly given an eviction notice on or about 1/9/25 and was not allowed to return to the facility. LPA met with Glenda Molinyawe, Administrator who contacted Lillian Sisayan, Licensee regarding todays visit. Glenda and Lillian was not aware there was an issue of receiving a resident back into the home. Upon further investigation, LPA obtained information that this did not occur to any of the residents at this facility. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Jan 13, 2025

Allegation investigated: Staff speak inappropriately towards a resident Staff do not allow a resident to file a complaint Staff threatened a resident with eviction

On 7/18/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to complete and deliver the findings for a complaint received on 5/16/24. LPA met with Administrator Glenda Molinyawe and explained the purpose of the visit. Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on records review, and staff and resident interviews, there is insufficient evidence to substantiate the allegations mentioned above. Based on resident interviews, 4 out of 6 residents stated staff did not speak inappropriately to residents. Residents reported that their personal rights were not being violated and that they have no concerns with care. Based on staff interviews, staff denied the allegations mentioned above, stating that they did not speak to resident (R1) inappropriately. Continued on 9099-C Unsubstantiated Staff stated R1 was allowed to file complaints as R1 has a personal cell phone. Staff also stated that R1 was never being threatened with eviction. Moreover, the investigation revealed that R1 is diagnosed of dementia with behavioral disturbance and schizoaffective behavior. R1 corroborated that the allegations above were false and that staff is good to R1. As a result of the investigation, LPA finds the allegation above to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and a copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Jul 18, 2024 · control 27-AS-20240516103544

Type of visit: Required - 1 Year

On 7/18/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a Required - 1 Year visit. LPA met with Administrator Glenda Molinyawe and explained the purpose of the visit. Administrator holds current certification and is expires on 5/20/2025. The facility is approved for five (5) non-ambulatory and 1 bedridden resident. Hospice approved for 2. There are currently six (6) residents in care. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, garage, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 107.1*F which was within the required range of 105-120*F. The temperature inside the facility measured at 73*F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. All emergency exits were clear from obstructions. Report continued on 809-C LPA requested resident and staff files for review. LPA reviewed (3) staff files and (4) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following forms and documents were requested to be submitted within 15 days: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed. Exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 18, 2024