Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
May 14, 2025
Visit Reason
An unannounced Required – 1 Year Inspection was conducted to evaluate compliance with licensing requirements and facility standards.
Findings
The facility was found to be in compliance with all applicable licensing requirements. No deficiencies were cited during the visit. The physical plant, kitchen, bedrooms, bathrooms, medication storage, and safety measures were all inspected and found satisfactory.
Report Facts
Resident files reviewed: 5
Staff files reviewed: 4
Licensed capacity: 6
Current census: 5
Fire extinguisher last serviced: Jan 27, 2025
Last emergency drill: May 1, 2025
Liability insurance expiration: Jul 13, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard Delarosa | Licensee/Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview. |
| Deborah Lee | Licensing Program Analyst | Conducted the inspection visit. |
| Eva M Alvarez | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Apr 22, 2024
Visit Reason
An unannounced Required – 1 Year Inspection was conducted to evaluate compliance with licensing regulations for the facility.
Findings
The facility was found to be in full compliance with no deficiencies cited. Observations included safe medication storage, adequate food supplies, proper maintenance of resident rooms and bathrooms, and complete staff and resident records.
Report Facts
Resident bedrooms checked: 5
Staff records reviewed: 5
Resident records reviewed: 5
Fire extinguisher last serviced: Jul 3, 2023
Hot water temperature range: 105-120
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard Delarosa | Licensee/Administrator | Met with Licensing Program Analyst during inspection |
| Socorro Leandro | Licensing Program Analyst | Conducted the inspection |
| Ulysses Coronel | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Apr 26, 2023
Visit Reason
An unannounced annual required visit was conducted using the new CARE Inspection Tool to evaluate compliance with licensing regulations for the facility.
Findings
The facility was found to be generally clean, well-maintained, and appropriately furnished with adequate supplies and safety equipment. However, a deficiency was noted regarding night supervision staff lacking required CPR and First Aid training.
Deficiencies (1)
| Description |
|---|
| Night supervision staff Tiffany Delarosa did not have CPR and First Aid training while on duty and on the premises at all times, posing a potential health, safety, or personal rights risk to persons in care. |
Report Facts
Capacity: 6
Census: 6
Hot water temperature: 117.8
Plan of Correction Due Date: May 5, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tiffany Delarosa | Named in deficiency for lacking CPR and First Aid training during night supervision | |
| Richard Delarosa | Administrator | Met with Licensing Program Analyst during inspection |
| Antonine Richard | Licensing Program Analyst | Conducted the inspection and authored the report |
| Ulysses Coronel | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Apr 8, 2022
Visit Reason
The visit was a pre-licensing evaluation conducted to assess the facility's readiness and compliance for initial licensing to serve individuals over 60 years of age.
Findings
During the pre-licensing inspection, no items were observed that did not comply with applicable laws and regulations. The facility was found to be in substantial compliance with all requirements.
Report Facts
Facility capacity: 6
Census: 0
Requested capacity: 5
Requested capacity: 0
Requested capacity: 1
Number of bedrooms: 6
Number of bathrooms: 3
Fire clearance date: Feb 21, 2022
Water temperature: 106
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard De La Rosa | Administrator | Applicant/Administrator met during pre-licensing evaluation |
| Jade Jordan | Licensing Program Analyst | Conducted the pre-licensing evaluation |
| Michael Cava | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Original Licensing
Capacity: 6
Deficiencies: 0
Mar 8, 2022
Visit Reason
The visit was conducted as an initial licensing evaluation (COMP II) for the facility to verify the applicant/administrator's understanding of California Code Title 22 Regulations and readiness for licensing.
Findings
The applicant/administrator participated in a telephone interview confirming understanding of facility operation, admission policies, staffing requirements, restrictive health conditions, general provisions, emergency preparedness, complaints and reporting, and pre-licensing readiness. Identification was verified and required documentation was obtained.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard Delarosa | Corporate Board Member and Administrator | Participant in COMP II interview and facility administrator |
| Julia Kim | Licensing Program Manager | Named as Licensing Program Manager on report |
| Bailey Humes | Licensing Program Analyst | Named as Licensing Program Analyst on report |
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