Routine inspection·March 6, 2025

On 03/06/2025 at 9:30AM, Licensing Program Analyst LPA T. Syess-Gibson conducted an unannounced Annual 1-Year required inspection. Caregiver Alice Cuntapay contacted the Administrator by phone. LPA toured the facility with caregiver Sakaraia Kata. The administrator currently holds a certificate (#7012574740) that expires on 08/15/2026. The facility’s fire clearance was approved for twelve (12) Non ambulatory and six (6) Bedridden residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of eleven (11) total bedrooms and three (3) bathrooms. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 73 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 115.8 degrees Fahrenheit. Night lights are maintained in hallways and passages to non private bathrooms. LPA observed residents’ bathrooms are equipped with grab bars no non slip mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/05/2024. First aid kit was observed to be complete. Fire drill was last conducted on 01/22/2024. Five (5) residents records were reviewed, two (2) out of five (5) were missing current appraisal needs and service plan. Five (5) staff records were reviewed, LPA observed during file review, S2 isn’t fingerprint cleared and S3 isn’t associated to the facility. Continue on LIC809C Continued from LIC809 The following deficiencies were observed: At 10:50AM LPA observed hand washing faucet in residents’ shared bathroom wasn't in good operating condition. At 10:55AM LPA observed two (2) walkers, three (3) Wheelchairs and one (1) Hoyer Lift located in the hallway blocking passageway. At 12:36PM LPA observed during file review S2 doesn’t have a criminal clearance. At 12:38PM LPA observed during file review S3 isn’t associated to facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 03/13/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Residents roster Updated facility sketch Liability Insurance Deficiencies cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. The total amount of civil penalties assessed on today's date is $750.00 for staff not being criminal background cleared and repeat deficiency.* Exit interview conducted. A copy of this report, LIC421FC, LIC421BG and appeal rights provided .