The facility is licensed to serve age range 60 and over, six (6) non-ambulatory of which one (1) may be bedridden. Hospice waiver for two (2). The facility is operating within the scope of their license with three (3) non-ambulatory residents.

The facility is a single-story home located in a residential area of Glendora. The home consists of a kitchen, living room, dining area, two (2) bathrooms, four (4) resident bedrooms, an attached garage, front and backyards.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. Smoke detectors were observed in the hall and in each resident bedroom. The carbon monoxide detector was not functional as it did not have a battery. Deficiency cited. Four (4) resident rooms were inspected and were observed to contain the required furniture and bedding, all in good repair. Extra, clean linens were observed in a hall closet.

continued on LIC809

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Water temperatures in grooming and bathing areas was measured at 103.7°F and 103.2°F, not within the required 105° – 120° F. Technical violation issued. Both bathroom sinks had slow water drainage, to the point that the sink filled during water temperature testing. LPA observed grab bars near toilets and inside showers. LPA did not observe slip-resistant mats, strips or flooring in showers. Deficiency cited.

LPA observed sufficient supply of non-perishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies.

The facility has Emergency Disaster Plan (LIC610E) in place. LPA advised facility to add a temporary shelter location outside of the immediate area. Technical violation issued. Last documented emergency drills were conducted on 03/04/2026. Fire extinguisher is located in the kitchen, last serviced 10/02/25.

Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. No pools or large bodies of water were observed. Construction of an ADU is almost complete.

LPA reviewed three (3) staff files. All files contained the following required documentation: current CPR and First Aid certificates for two (2) of three (3), personnel records, Health screening with TB clearance, fingerprint clearance and job application for three (3) of three (3) personnel records reviewed.

LPA reviewed Resident files for three (3) residents. Resident files are maintained at the facility and contain the following required documents: Admission Agreement, Physician's Report (including T.B. clearance and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Medications are centrally stored in a locked kitchen cabinet. Facility keeps a record of centrally stored prescription medications for each resident.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D.

Exit interview held and a copy of the report, LIC809D and appeal rights were provided to Caregiver Noel Navarro.