Inspection Report
Census: 6
Capacity: 6
Deficiencies: 1
Oct 2, 2025
Visit Reason
Licensing Program Analyst Jessica Cho arrived unannounced on a Case-Management visit for the purpose of issuing a deficiency related to unapproved structural modifications within the facility.
Findings
Structural modifications were found within the garage area, which was not approved by the Fire Marshall. The facility was found not in compliance with fire clearance requirements, resulting in a deficiency and an Immediate Civil Penalty.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to maintain a fire clearance approved by the city, county, or State Fire Marshal due to unapproved structural modifications within the garage. | Type A |
Report Facts
Capacity: 6
Census: 6
Plan of Correction Due Date: Oct 3, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyana Fisk | Administrator | Met with Licensing Program Analyst during inspection and authorized exit interview |
| Evelyn Macalino | Caregiver | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Jessica Cho | Licensing Program Analyst | Conducted the unannounced case management visit and issued deficiency |
| Lourdes Montoya | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Sep 18, 2025
Visit Reason
The inspection was an unannounced Required 1-Year annual evaluation conducted using the CARE Inspection Tool to assess compliance with licensing requirements.
Findings
The facility was found to be operating within the conditions and limitations specified on the license with no deficiencies cited. Advisory notes were issued regarding the size of a posted notice and the need to conduct quarterly disaster drills. Structural changes may be followed up on later.
Report Facts
Residents receiving hospice service: 4
Fire extinguisher service date: Jun 9, 2025
Emergency drills conducted: 1
Hot water temperature range: Measured between 113.0 and 116.7 degrees Fahrenheit in bathrooms.
Facility capacity: 6
Facility census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyana Fisk | Administrator | Administrator present during inspection and exit interview. |
| Jessica Cho | Licensing Program Analyst | Conducted the inspection. |
| Katherine Borja | Caregiver | Greeted Licensing Program Analyst upon arrival. |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jun 13, 2024
Visit Reason
The visit was an unannounced annual required inspection conducted by the Licensing Program Analyst to evaluate compliance with regulations.
Findings
No deficiencies were noted during the inspection. The facility met all regulatory requirements including safety measures, medication storage, resident records, and employee clearances.
Report Facts
Fire extinguisher service date: Jun 4, 2024
Fire drill frequency: 3
Hot water temperature: 119.8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ruth Martinez | Licensing Program Analyst | Conducted the inspection visit |
| Tyana Fisk | Administrator | Met with Licensing Program Analyst during inspection |
| Armando J Lucero | Licensing Program Manager | Named in report signature section |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jun 6, 2022
Visit Reason
Licensing Program Analyst Albert Marin conducted an unannounced required annual inspection of the facility to evaluate compliance with licensing regulations.
Findings
The facility was found to be in good repair with functional safety equipment and adherence to COVID-19 mitigation protocols. No citations were issued during this visit.
Report Facts
Residents under hospice care: 3
Facility capacity: 6
Current census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyana Fisk | Administrator | Met with Licensing Program Analyst during inspection and discussed facility compliance |
| Albert Marin | Licensing Program Analyst | Conducted the unannounced required annual inspection |
Inspection Report
Census: 5
Capacity: 6
Deficiencies: 0
Oct 21, 2021
Visit Reason
Licensing Program Analyst Albert Marin made an unannounced visit to discuss and review a request from the Administrator for an increase in hospice waiver, which had been approved prior to the visit.
Findings
The Licensing Program Analyst toured the facility, observed five residents and two staff members, discussed hospice waiver terms with the Administrator, and conducted an exit interview. The report and updated license were left at the facility.
Report Facts
Residents observed: 5
Staff observed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyana Fisk | Administrator | Administrator consulted during the visit and discussed hospice waiver terms |
| Albert Marin | Licensing Program Analyst | Conducted the unannounced visit and exit interview |
| Luz Adams | Licensing Program Manager | Approved the hospice waiver request |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Jul 12, 2021
Visit Reason
An unannounced required annual inspection was conducted to evaluate the facility's compliance with regulatory standards.
Findings
The facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. The environment was safe, clean, and well-maintained, with all safety equipment operational and adequate food and medication storage.
Report Facts
Residents under hospice care: 3
Staff members observed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyana Fisk | Administrator | Met with Licensing Program Analyst during the inspection and exit interview |
| Albert Marin | Licensing Program Analyst | Conducted the inspection and exit interview |
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