Routine inspection·September 30, 2025

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Compliance and Training Coordinator Julissa Aguirre and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 10 residents. At approximately 8:30AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and outdoor courtyards. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required seven-day non-perishable and two-day perishable supply of food. LPA observed several flies in the dinning room during this visit. Facility has EcoLab fly traps located throughout the facility, but the traps appeared to not have been maintained. Emergency food stores and water was present to ensure facility can be self-sufficient for 72 hours. Facility has a generator to supply power in an emergency. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 10:30AM, LPA reviewed 10 of 55 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. Documentation of a physician visit within the last 12 months was present. Medication records were organized and contained orders for each medication. Medications were secured. Continued on LIC809-C… During this inspection, LPA followed up on several Unusual Incident Reports submitted by the facility. On 07/27/2025, Staff provided a resident with the wrong medication. The report states the staff misread the room number on a prepared medication cup. Staff notified residents physician of the error and resident was taken to the emergency room for observation. On 09/08/2025, staff discovered an error that occurred where a resident was given the wrong dose of a medication. Staff notified residents physician of the error and resident was monitored. On 09/28/2025, Staff provided a resident with the wrong medication. The report states staff did not verify what medication was in their hand before giving it to the resident. At approximately 1:30PM, LPA reviewed 10 staff files. Staff files reviewed did not contain evidence of completed annual training in 8 of 10 files. There was at least one staff on duty with CPR certification during this visit. All employees requiring background checks are cleared. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Evidence of control of Property, (Current Rental/Lease Agreement/Deed) LIC500- Personnel Report LIC610E- Disaster Plan Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Julissa Aguirre and Appeal rights were given.