Routine inspection·June 19, 2025

On 06/19/25 around 10:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by a and Co-Administrator Shalini Bhutani (ADM) arrived about 10 minute later. The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for three (3). Upon entry LPA observed two residents having lunch. LPA reviewed the resident and staff files and Emergency Disaster Plan (EDP). LPA observed a visitor sign-in log at the entry. LPA and ADM toured the facility, including but not limited to bedrooms, bathroom, kitchen, laundry room, common area, front yard and backyard. The facility consists of four (4) total bedrooms. All indoor passageways were free of obstruction. There aren't any bodies of water. A comfortable temperature for residents was maintained at 74 degrees Fahrenheit (F), and the water temperature measured at 114.5 for the comfort and safety of all the residents. The bathroom was safe, sanitary and in operating condition. Hand washing posters, paper towels, and soap observed at hand washing stations. Linen and hygiene supplies were available for all residents. PPE and paper goods remain sufficient. There is a minimum supply of 2-day perishables and 7-days of non-perishable foods. continued on LIC809C... ...continued from LIC809 Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguisher last serviced on 03/06/25, first aid kit complete and next emergency disaster drill to be conducted for the next quarter. The following forms are to be updated and submitted to CCLD on or before 06/27/25: - LIC 610D Emergency Disaster Plan (Reviewed) - Facility sketch (Reviewed) - LIC 200 (Reviewed) - Liability Insurance - LIC500 Personnel Report - LIC308 Designation of Administrative Responsibility - An updated copy of Administrator Certificate(s) Exit interview conducted and a copy of this report provided to Sheeva Bhutani, Co-Administrator (ADM)