Routine inspection·December 28, 2023

Licensing Program Analyst (LPA) A. Gomez conducted an unannounced 1 Year Required visit on this date at 1:40pm. Upon arrival, LPA were greeted by Caregiver, Benjamin Filomeno. Administrator, Pamela Chan and Licensee Bernadette O'shea arrived at 1:50pm. The Administrator currently holds a certificate (#6012925740) that expires on 04/24/2024. The facility’s fire clearance is approved for six non-ambulatory of which one may be bedridden. LPA toured the facility with Administrator, including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. LPA observed pool is secured with a fence around the perimeter. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Emergency Disaster Plan was last posted on 12/28/2023 . Fire extinguisher was last services 12/20/2023. First aid kit was observed to be complete. Disaster Drill was last conducted on 11/30/2023. LPA reviewed 4 staff records and 4 of 4 staff have current first aid certificates. LPAs reviewed 5 of 5 residents records. Report continues on LIC 809-C Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 1/14/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies were cited during visit. Exit interview conducted an a copy of this report provided.