Routine inspection·May 7, 2025

On 05/07/2025, Licensing Program Analysts (LPA) Triel Lindstrom and Arielle Pascua arrived at the facility to conduct an unannounced annual inspection. LPAs Lindstrom and Pascua identified themselves, explained the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). DFA Jacob Harryman (Administrator Certificate # 6071704740, expiration date 07/30/2026) was on-site and a brief interview followed. DFA Harryman led LPAs Lindstrom and Pascua on a tour of the facility and accompanied LPAs on their inspection of interior and exterior areas of the facility. This facility is a four-story apartment building that is licensed to serve 78 residents, including 59 nonambulatory and 19 ambulatory individuals. The facility offers licensed care on the first through third floors, including memory care on the first floor and assisted living on the second and third floors. The fourth floor is independent living. It has a hospice waiver for 6. Its fire clearance was issued by Angels Camp Fire Department on 02/08/2021. The current census is 50 residents in licensed care. The annual inspection began with a records review. LPA Lindstrom requested and reviewed three resident files and five staff files. Each staff file contained the required documentation, including First Aid/CPR certification, criminal background clearance, and TB test results. Each resident file contained the required documentation, including ofpre-appraisals, admission agreements, and physician reports. LPAs Lindstrom and Pascua then inspected the physical plant including but not limited to the dining area, kitchen, storage rooms, common areas, resident bedrooms and bathrooms, laundry rooms, and outside patios to ensure compliance with Title 22 regulations. The Administrator Certificate, Facility License, Complaint Hotline Poster, Ombudsman information, menus, activity calendars, and resident personal rights are publicly posted. LPAs Lindstrom and Pascua toured the kitchen and observed a two-day supply of perishable food and seven-day supply of non-perishable food, located in a storage room, walk-in freezer, and walk-in refrigerator. Food is properly stored. Appliances are in working order, except for the AC unit in the walk-in freezer. DFA Harryman stated that repairs are scheduled for tomorrow. The range hood was recently cleaned. LPAs Lindstrom and Pascua observed food debris and grease on the sides of appliances, walls, lower shelves of counter units, slip mats, and floors of the kitchens and walk-ins. Additionally, LPAs Lindstrom and Pascua observed that the linoleoum floor tiles in the kitchen and the carpet in the passage way leading into the kitchen is discolored over a large portion of it. LPAs Lindstrom and Pascua then toured common areas intended for resident use. These were clean and odor-free. These areas have adequate furnishing, lamps, and lighting, as well as decorations on the wall. Several residents were observed sitting in these areas, talking to each other and guests. The outside patios on both the assisted living and memory care floors have outdoor chairs and tables in good repair, with views of the surrounding trees and hills. LPAs Lindstrom and Pascua toured resident living quarters. These are clean and odor-free. Apartment units have updated appliances and fixtures, operable and intact windows and doors, and flooring in good repair. The water fixtures work, toilets flush, grab bars are present and sturdy, and non-slip mats are in good condition. LPA Pascua measured the temperature of the hot water in one resident bathroom sink. Hot water temperature was measured at 118.4 degrees Fahrenheit, which is within the required regulation of 105 to 120 degrees Fahrenheit. LPAs Lindstrom and Pascua then toured the locked central medication storage area. All medication is in a locked medication cart. Along with staff, LPA Lindstrom reviewed and compared medication to medication administration records. Inside temperature was within the required regulatory range. LPA Lindstrom tested two smoke and carbon monoxide detectors and found them in working condition. There were evacuation chairs in the stairwells on each floor. The elevators were inspected on 04/12/2025. LPA Lindstrom requested that updated copies of these documents be emailed to her by 5:00 PM on May 14, 2025: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report (7) LIC 309 Administrator Organization A technical violation was issued for Section 87303(a). As a result of this annual visit, the facility is in compliance with Title 22 Regulation. There are no deficiencies at this time. An exit interview was conducted with DFA Jacob Harryman, and a copy of this LIC 809 report was provided to the facility.