Pico de Loro.

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit in order to verify the Plan of Correction (POC) issued on 10/03/2025. LPA met with Administrator, Genesis Yamberly Garcia, who was informed of the purpose of the visit. LPA conducted record review and interviews during the time of the visit. Findings for complaint #18-AS-20250513170142 resulted in a deficiency cited for 87468.1(a)(27) Additional Personal Rights of Residents in Privately Operated Facilities for a resident being overcharged for room and board. The plan of correction was for the licensee to repay R1 the overcharged fee, and document a new procedure to account for Room and Board expenses and resident Personal and Incident funds. LPA received on 10/03/2025 documentation of R1 receiving the money owed, retraining of business office staff on new procedure for account for funds for residents was received. During the time of the visit, LPA interview R1 and confirmed the amount was received and is being safeguarded. Therefore, the POC has been met and the deficiency was cleared at the time of the visit. An exit interview was conducted where this report, and clearance letter was reviewed and provided.

However, an additional interview conducted with R1 on 07/24/2025, revealed R1 reported they had been upset with the licensee prior and had made false allegations about the facility and the finances. R1 claimed the false allegation was R1 not authorizing the facility as the payee, when in fact she did give authorization for the change. R1 also revealed during the 07/24/2025 interview, that R1 no longer wished to change the payee. R1 wanted Pico De Loro to continue to be the payee and R1 had no issues with the facility. The administrator provided form “Advanced Notice of Representative Payment” which revealed the facility was chosen to be R1’s payee by the Social Security Administration and was signed on 09/24/2024 by R1 and the administrator as a witness. Interviews with the Licensee and the administrator revealed R1 consented to the facility being their payee. A review of R1’s Physician Report dated 11/10/2024 revealed R1 could handle their own finances, and report was marked “no” under confused or disoriented. R1’s admission agreement dated 11/30/2023 revealed R1 was their own responsible party. Interview with R1 on 04/02/2025 revealed the facility had taken R1’s bank card. R1 also recanted this allegation on 07/24/2025 and claimed the allegation was because R1 upset with the facility. R1 further revealed in the 07/24/2025 interview, that the administrator assisted R1 by taking them to the bank but denied that the administrator took possession of the bank card. R1 stated the administrator assisted them in regaining access to their bank account when they had been locked out. Interview with the licensee and the administrator revealed, administrator corroborated that they had assisted R1 to the bank and assisted R1 in obtaining a new bank card and bank account details. Both staff revealed that R1 consented to safeguarding their personal belongings at the facility and showed the LPA a signed form “Authorization to Handle Debit Card” signed 12/01/2023 for R1. 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 On 07/24/2025 LPA observed the locked safe where the facility safeguards resident personal information, including R1’s debit card. LPA also observed R1 had their bank card in their possession at the time of the visit, with the administrator reporting R1 had requested their card earlier that day. Both the administrator and R1 revealed the facility safeguards the card and gives the card to R1 when they request it. It was alleged facility took the bank card and PIN from Resident 2 (R2) as well. R2 was interviewed and denied the licensee took their bank cards and PIN numbers. R2 stated only they have access to their bank cards. LPA interviewed the administrator and the licensee. Both staff denied they asked R2 for their bank card or PIN. Interview with R2’s roommate revealed they were not aware of the licensee requesting R2’s bank card or PIN number. Interview with R2’s responsible party revealed only they handle R2’s finances and were not aware of the licensee requesting R1’s bank card or PIN number. A review of R2’s file revealed no agreement to handle or safeguard R2’s bank card by the facility. During the LPA’s observation of the locked safe, R2’s bank card was not in the safe. Therefore, based on interviews, record reviews, and observation the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and a copy of this report was provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation #3: Staff are barricading the residents while in care. The complaint alleges that the staff at the facility barricaded Resident #1 (R1) while in care. It is reported that (R1) is unable to leave the facility, as the doors are secured with chains. No additional details were provided regarding this situation. On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to corroborate this claim. (R2-R7) asserted that the facility's doors are not secured with chains, which restricts their ability to leave the premises. Furthermore, no residents are prohibited from leaving the facility. (R1) firmly stated that this claim is invalid. (R1) confirmed (R1's) independence and said that (R1) can leave the facility unattended. (R1) expressed the ability to be independent and continued to drive a vehicle without any restrictions on leaving the premises. On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to validate this claim. (S1-S6) stated (R1) is independent and can leave the facility no assistance. According to (S1-S3), (R1) enjoys the liberty of exploring various rooms within the premises freely. The environment is open and accessible, there are no locked chains on the doors that would serve as barriers. (R1) has the freedom to leave the facility with no assistance at any time without any restrictions. As a result of review of Resident #1 (R1's) Physicians Report LIC 624A (dated 09/19/24 & 01/05/23) revealed the (R1) is able to leave the facility unassisted. A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly. During the visit on August 9, 2025, the Department observed that the facility actively promotes the rights of its residents. The facility had posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster prominently displayed throughout the premises. An inspection of the premises and (R1’s) room on August 10, 2025 and November 13, 2025 revealed no restricted chains on any doors. (Evaluation Report continues LIC 9099-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 Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Based on the information collected from the facility inspections, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated . An exit interview was conducted with the Genessis Garcia, and copies of the reports were provided. 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 INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff forged a confidential document for a resident. The complaint alleged that staff at the facility forged a confidential document for Resident #1 (R1), a life-sustaining form. This form, featuring signatures from both (R1) and the primary physician at the facility, was completed in April 2023. However, (R1) was only made aware of the forgery on October 19, 2023. No additional details were provided regarding this matter. On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to validate this claim. (R2-R7) indicated they were aware of signing confidential records and had no issues or concerns with their confidential documents. (R1) claimed that this assertion is false. Furthermore, (R1) confirmed that the signature on the Physician’s Order for Life Sustaining Treatment (POLST) form is indeed (R1’s) signature, eliminating any possibility of it being forged. On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to validate this claim. (S1-S3) indicated that (R1) was admitted to the facility without having a power of attorney, conservator, or public guardian representing (R1). (R1) signed all confidential agreement documents, including the life-sustaining record. (S1-S6) all claimed to have completed Personal Rights in Residential Care Facilities for the Elderly (RCFE). A review of Resident #1 (R1's) Physician's Orders for Life Sustaining Treatment (POLST) (dated 04/06/23), Identification and Emergency Information LIC 601 (dated 01/04/23), Residential Care for Elderly Admission Agreement (dated 01/04/23), Admission Financial Agreement (dated 01/04/23), and Preplacement Appraisal LIC 603 (dated 07/28/22) revealed all had identical signature to (POLST). Further review of Physician's Orders (dated 06/26/25) listed (R1) is prescribed a total of (14) medications. It revealed that (12) out of the (14) medications have side effects of cognitive effects, depression, anxiety, confusion, or dizziness (ref: National Institute of Health). A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly. (Evaluation Report continues LIC 9099-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 During the visit on August 9, 2025, the Department observed that the facility actively promotes the rights of its residents. The facility had posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster prominently displayed throughout the premises. Based on the information gathered, there is not enough evidence to corroborate the allegation mentioned above. Allegation #2: Staff are financially abusing a resident while in care. The complaint alleges that the staff are financially abusing Resident #1 (R1). It has been reported that the facility's administrator is withholding (R1’s) money and checks, as well as (R1’s) bank statements. The administrator only provides (R1) with $100 in cash, while the remainder of the funds goes to the facility. No additional details were provided regarding this matter. On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to support this claim. (R2-R7) stated that they had no issues or concerns regarding their financial matters, as the facility's administrators do not manage their finances. (R1) asserted that the claim is incorrect. Additionally, (R1) stated that (R1) independently manages (R1’s) finances and that no one else has access to (R1’s) financial bank accounts. On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to support this claim. (S1-S3) indicated that (R1) self-admitted to Pico De Loro on January 4, 2023. They stated that the facility does not manage (R1's) finances; (R1's) rent expenses will be covered through (R1's) personal bank account. Additionally, the facility does not maintain any Personal and Incidental funds for (R1). A review of Resident #1 (R1's) Physicians Report LIC 624A (dated 09/19/24 & 01/05/23) revealed that (R1) has the capacity for self-care and can manage cash resources. Further review of Rent Receipts (dated 01/01/23 through 07/31/23) validated that (R1) handles (R1’s) finances. A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly. (Evaluation Reports continues LIC 9099-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 During the visit on August 9, 2025, the Department observed that the facility actively promotes the rights of its residents. The facility had posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster prominently displayed throughout the premises. Based on the information gathered, there is not enough evidence to corroborate the allegation mentioned above. Based on the information collected from the facility inspections, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are Unsubstantiated . An exit interview was conducted with the Genessis Garcia, and copies of the reports were provided.

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced required annual visit. LPA met with Administrator, Yamberly Genesis Garcia, and Licensee Efren Rilo who were informed of the purpose of the visit. The facility is a one story building with resident bedrooms, bathrooms, shower rooms, staff office, activity spaces, and outdoor spaces. The facility does not have a pool or firearms. The facility is a residential care facility for the elderly ages 59 and above, approved for (45) non ambulatory resident, all of which may be bedridden, and approved for locked perimeter. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. LPA observed locked dangerous items, such as centrally stored medication, sharps, and cleaning supplies. Documentation was provided showing carbon monoxide, smoke detectors and fire extinguishers were charged and tested July of 2025 and are operational. LPA observed the facility signaling system is operation and location in resident bedrooms and bathrooms. Hot water temperature was recorded at 105F in a resident bathroom. The facility has cleaning supplies to conduct regular cleaning of the facility, and personal hygiene supplies for the residents. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 7- day non perishable and 2-day perishable food items. The menus are posted and resident's prescribed diets and allergies are accessible to kitchen staff. 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 LPA reviewed the staff schedule for staff coverage. LPA observed staff rounding and active care and supervision of residents. The current administrator has a current certificate. Required postings are found in the facility. LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing last fire drill conducted on 7/2025. Record Review and Resident/Staff Files: LPA reviewed (3) staff files which possess all required documents such as criminal record clearances and training including CPR and First aide training. (5) resident files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All resident medication was locked in a medication room. LPA reviewed (3) resident medication lists and found medication accounted for. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was reviewed and provided. *LPA was off site from 11:38am to 1:38pm in order to prepare today's report.

Information obtained from interview with R1 did not indicate they had any bruises, due to R1 not able to coherently answer questions pertaining to the allegation. Information obtained from interview with R2 indicated there was no hitting and/or fighting, between them. Additionally, there were no interactions between R1 and R2. Information obtained from interviews with additional residents stated they were not aware of any of the residents being involved in any kind of altercation. Residents were unable to advise if they observed R1 to have a bruised eye or hand. LPA’s review of the records confirmed R1 and R2 had been receiving services through hospice care since being admitted to the facility. LPA made several attempts to obtain hospice notes regarding whether R1 was observed to have a bruised eye or hand. LPA was unable to obtain any additional documents. On 03/28/2024, LPA made observations of R1 and observed skin discoloration on R1’s hands, however, LPA did not observe any bruising to the eyes. Based on information obtained from interviews, record reviews, and observations, the information obtained regarding the allegation staff did not prevent residents from getting injured while in care was not sufficient. Due to the inability to obtain pertinent documentation, and additional hospice records, the allegation has been deemed unsubstantiated. An allegation deemed unsubstantiated means although the allegation may have happened, but there is not a preponderance of the evidence to demonstrate if the alleged violation did nor did not occur. An exit interview was conducted, and a copy of this report was discussed and provided to Administrator, Genessis Garcia.

LPA conducted an unannounced visit to the facility on 04/02/2025 and observed the facility entrance and emergency exits were free of obstructions. Based on file review, the facility’s license permits for locked perimeters per the local fire jurisdiction. LPA observed this is being observed with locked exterior gates and locked door leading to residents rooms, bathrooms and dinning area. LPA interviewed (5) residents. Interview with R1 revealed staff do not allow them to leave the facility. Interview with (4) residents revealed they are allowed to go out into the community with permission from their doctor or with assistance of visitors. LPA interviewed (4) staff who revealed some residents are allowed to leave on their own, while others must be accompanied by a family member. (4) of (4) staff revealed this is based on the resident's medical assessment by their doctor. (4) of (4) staff revealed R1 is able to leave with family or friends and stated that on the week of 05/05/2025 R1 left the facility with visitors and returned. R1's physician's report dated 01/29/2025 revealed R1 is unable to leave the facility unassisted. LPA reviewed the Resident Sign out Log which revealed resident sign out when assisted by visitors, and some residents are able to sign themselves out. On 05/01/2025 R1 signed out to go to the store at 11:50am. Therefore, the allegation that R1 and other residents cannot come and go as they please and are being locked into the facility is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

LPA attempted to conducted interview with S1, but they were unavailable for interview. LPA conducted interview with (5) staff who worked at the facility May of 2024. (5) of (5) staff revealed S1 was at the facility almost every day. The staff revealed S1 was seen continuously and from morning to afternoon at the facility. LPA conducted (5) resident interviews. (3) of (5) residents stated they did not know who S1 was, while (2) of (5) resident's stated they regularly see S1 at the facility checking on residents. LPA attempted to conduct records review for staff schedule from March 2024, however none was available at the time of the visit. Therefore, the allegation that S1 was not present at the facility enough hours to oversee the operations is unsubstantiated. It was alleged " Facility did not ensure that there were sufficient staff on the premises to assist and monitor residents." It was alleged around May of 2024 only (2) staff were present at the facility. It was also alleged the week of 09/16/2024 there were only (3) staff present at the facility. LPA attempted to interview S1 on staffing, but S1 was unavailable for interview. LPA interviewed (5) staff who worked May and September of 2024 at the facility who denied the facility is short staffed. LPA interviewed (5) residents. (4) of (5) stated there are enough staff at the facility to check on residents every 30 minutes, and residents use call buttons to summon staff. (1) of (4) residents stated the facility is short staffed and stated they are often short (1) care giver. LPA attempted to conduct records review for staff schedule from March 2024 and September of 2024, however none was available at the time of the visit. LPA conducted record review of the current schedule and observed staff present during the visit who were checking on residents and assisting residents with activities of daily living. LPA observed (5) staff present during the visit. Therefore, the allegation that staff is not present at the facility enough hours to monitor the residents is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

Licensing Program Analyst (LPA) Sara Martinez conducted an announced case management visit to increase the capacity per licensee request. LPA met with Administrator Efren Rillo and Administrator Assistant Earlienne Rillo and explained the purpose of the visit. At the time of visit there were 42 residents. Licensee requested a capacity increase from forty-three (43) residents to forty-five (45) residents. A Fire Clearance was approved on 09/10/2024 for two (2) additional non-ambulatory residents, of which of the 2 may also be bedridden. Facility sketch on file shows sufficient square footage in the facility and activity rooms to accommodate the requested capacity. LPA Martinez discussed the facility sketch with Licensee which provided amble space for 45 residents. LPA Martinez toured the interior/exterior of the building and visually inspected the resident bedrooms. LPA Martinez confirmed that all identified shared rooms are large enough to accommodate the required furniture for two residents without inhibiting movement into and throughout the rooms. The facility has 23 bedrooms for the residents with 21 bedrooms containing an attached bathroom. The facility has 4 additional bathrooms located throughout the facility. LPA Martinez additionally confirmed that there are sufficient bathrooms in the facility to meet Title 22 requirements for ratio of residents to bathrooms. The physical plant is ready for increase in capacity. LPA will submit file for capacity increase approval. The final approval of capacity increase is contingent upon LPM's final file review. Licensee will be notified by LPA once capacity increase has been approved by licensing. If capacity increase is approved, new license will follow in the mail after phone notification by LPA with Licensee. An exit interview was conducted where this report was discussed with and a copy was provided to Rillo.

On September 24, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility to conduct an unannounced collateral visit. LPA conducted interviews for an unrelated matter to the facility. The collateral visit was conducted to make observations, interviews and records reviews pertaining to another matter. The LPA met with Lead Med-Tech, Maria Valencia introduced herself and stated the purpose of the visit. LPA Mixson toured the facility along, with Med-Tech and made observations relating to another matter altogether and interviewed Resident Number 1 (R1) who is also the (Reporting Party), from the previous matter. There were no health and safety concerns or issues observed during the time of this visit. The facility was clean and well maintained there were no obstructions to the inside or outside passageways. LPA Mixson reviewed several resident files and made observations to the other matter being investigated. LPA Mixson reviewed the daily notes written pertaining to Resident Number 1 (R1). LPA Mixson requested and received pertinent documentation pertaining to R1. An exit interview was conducted a copy of this report was discussed and given to Med-Tech, Maria Valencia

LPA conducted interviews with (4) staff scheduled on Monday 4/22/2024, who denied there was no staff working on this date. Around 10:30am, staff reported activities are taking place at the facility, and staff are walking around to ensure residents in their rooms are supervised. LPA conducted (4) resident interviews which revealed that staff come and assist the residents and check on them. During today’s visit LPA was at the facility from 8:40am to 11:30am and observed staff was present in the kitchen, resident rooms, and common areas. Therefore, based on interviews, records review and observation the allegation that no staff were present at the facility on Monday 4/22/2024 is unsubstantiated. It was alleged that " Staff did not keep the facility clean or sanitary" . LPA conducted a walk through of the facility, including common areas, kitchen, resident rooms, bathrooms, and outdoor area. LPA observed the facility was clean and sanitary. LPA observed the cleaning supplies the facility utilizes to conduct regular cleaning of the facility, as well as hygiene and incontinent supplies for residents. LPA conducted (6) staff interviews, which revealed conflicting information. (1) staff interview revealed housekeeping staff do not always keep the facility clean, however (5) staff reported the facility is kept clean and all staff work together to help keep it clean. LPA conducted (4) resident interviews which revealed that staff keep their rooms clean and conduct laundry regularly. Therefore, based on interviews and observations LPA found that the allegation is unsubstantiated. It was alleged that " Staff did not ensure that residents were adequately fed", and facility residents appeared to be malnourished and “drugged”. LPA conducted a tour of the facility including the common areas, resident rooms and bathrooms, and outdoor areas. LPA found observed residents engaging in activities, and in their rooms. No health or safety issues were observed concerning the care of the residents. LPA also reviewed the facility menu, and conducted a walk through of the facility kitchen and found the facility meets the required food supply. LPA conducted (6) staff interviews who denied that residents are malnourished and being fed. LPA conducted (4) resident interviews which revealed that residents are being fed and there is enough food for the residents. Therefore, based on interviews, records review and observations, LPA found the allegation is unsubstantiated. Findings that are unsubstantiated mean that although the allegation is valid, the preponderance of the evidence standard has not been met. An exit interview was conducted with Administrator, Efren Rillo where this report was reviewed and provided to them.

During file review LPA found the facility was approved for a locked perimeter due to admissions of residents with dementia served. LPA's record review, observation, and interviews provided no information that could corroborate or refute validity of the allegation. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. 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. An exit interview was conducted and a copy of this report was reviewed with and provided to Administrator Efren Rillo.

Licensing Program Analyst (LPA) Sara Martinez conducted an announced case management visit to increase the capacity per licensee request. LPA met with Administrator Efren Rillo and Assistant Administrator Earlienne Rillo and explained the purpose of the visit. At the time of visit there were 38 residents. Licensee requested a capacity increase from thirty-nine (39) residents to forty-three (43) residents. A Fire Clearance was approved on 08/08/2023 for four (4) additional non-ambulatory resident, which of the 4 may also be bedridden. Facility sketch on file shows sufficient square footage in the facility and activity rooms to accommodate the requested capacity. LPA Martinez discussed the facility sketch with Licensee which provided amble space for 43 residents. LPA Martinez toured the interior/exterior of the building and visually inspected the resident bedrooms. LPA Martinez confirmed that all identified shared rooms are large enough to accommodate the required furniture for two residents without inhibiting movement into and throughout the rooms. The facility has 22 bedrooms for the residents with 21 bedrooms containing an attached bathroom. The facility has 4 additional bathrooms located throughout the facility. LPA Martinez additionally confirmed that there are sufficient bathrooms in the facility to meet Title 22 requirements for ratio of residents to bathrooms. The physical plant is ready for increase in capacity. LPA will submit file for capacity increase approval. The final approval of capacity increase is contingent upon LPM's final file review. Licensee will be notified by LPA once capacity increase has been approved by licensing. If capacity increase is approved, new license will follow in the mail after phone notification by LPA with Licensee. An exit interview was conducted where this report was discussed with and a copy was provided to Efren Rillo.

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that thirty-eight (38) clients attend this day program and there are currently eight (8) staff members present. The Administrator, Efren Rillo (S1) conducted the facility tour. There is an Infection Control Plan on file. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA reviewed client records. Six (6) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/and Staffing- LPAs began review of employee records- Five (5) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Efren Rillo, Administrator’s license expiration date is 12/24/2024. Food Service- Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. (Continued on LIC809C) 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 (Continuation from LIC809) Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 110.0 degrees F. Laundry is done in the laundry room. There is a locked room for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is a secured fireplace at this facility. There is not a pool at the facility. The last fire drill was conducted on 06/23/2023 by the Fire Department. Medications - are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed five (5) fire and ten (10) carbon monoxide detectors. There was six (6) fire extinguisher on site. Based on the information received during this visit today in the areas reviewed, there are zero (0) deficiencies observed per Title 22, Division 6 of The California Code of Regulations Article 06. This LIC 809 was reviewed with, and a copy will be provided to the Administrator, Efren Rillo.