Aegis Residential Living.

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Administrator (Admin) Jennifer Perez and explained the reason for the visit. Administrator provided proof of administrator's course work which completed on June 25, 2025. The facility is a single story structure and is licensed to provide services for age range 60 and over for six non-ambulatory residents. A waiver was granted to provide hospice services to two residents at one time. During today's visit, there are six residents in care of which one is under hospice and two staff on duty. LPA toured the physical plant with Admin Perez. Facility is clean and sanitary. LPA observed four resident bedrooms and two resident bathrooms. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 108.6 and 107.4 degrees Fahrenheit in the resident bathrooms. All common areas were inspected including the detached two car garage. The swimming pool gate is secured and the fire place is properly screened. LPA reviewed the Emergency Disaster Plan (LIC610E) and observed sufficient emergency food and water in the garage. The 610E was not reviewed annually and the emergency drills were not conducted quarterly. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction, the exit gates are operational, and there were sufficient seating and shading. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The fire extinguisher was purchased on August 21, 2025 as verified per the purchase receipt. The auditory devices and smoke/carbon monoxide detectors were tested and operational. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the correct size. LPA conducted a review of all resident/staff files. Discrepancy noted with resident files as five out of six residents did not have a current reappraisal. Two out of two staff are not CPR/First Aid certified and did not complete their annual 20 hour training for this year. Medications were audited in six out out of six residents. Discrepancies noted in two out of six residents as medications were not administered as prescribed. An interview was conducted with one resident due to insufficient time. LPA discussed the following areas: to ensure reappraisals for all residents are completed as frequently as necessary or annually, medications are administered as prescribed, to ensure at least one staff per shift is CPR/First Aid certified, to ensure staff are receiving their 20 hour annual training, to conduct quarterly emergency drills per shift, to review the LIC610E annually and update as necessary, and to ensure timely payments of the annual licensing fee due on August 24, 2025. Based on the observations made during today's visit, deficiencies are being cited, and Technical Violations are also being issued. An exit interview was conducted with Administrator Jennifer Perez, and a copy of this report was provided at exit.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregivers after introducing himself and stating the reason of the visit. Licensee Salvador Diaz and administrator Jennifer Perez were notified by phone and arrived later to assist. During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one story home with two private and two shared bedrooms and one staff room in addition to the facility's common living areas and two shared bathrooms. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. Postural supports observed in one room with corresponding physician orders verified to be on file. There are currently six residents admitted to the facility with two receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets are operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. A fire and emergency drill was conducted in July 2024 along with an update of emergency supplies but was not documented at the time. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food. Smoke and carbon monoxide detectors tested operational. Fire extinguisher present are observed to be fully charged. There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on both sides of the house and routes of egress are free of obstructions. There is a pool present in the backyard with adequate fencing confirmed to be present. Residents are encouraged to use the pool under staff supervision. CONTINUED ON FORM LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 CONTINUED FROM FORM LIC809 Medication, sharp items and cleaning supplies were confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed six resident files and two staff files. One medical assessments for a resident with an indication of dementia were found to be outdated and will need an update. One staff health screening form is observed to be blank. Admission agreements signatures are incomplete in several forms and corrected during the visit. Based on the observations made during today’s inspection, two type B deficiencies and seven advisory notes are being issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.