Routine inspection·June 5, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 12:10PM. LPA met with staff upon arrival and Administrator Vanessa Havsgaard. Entrance interview conducted. At 12:15PM, the LPA along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN/LAUNDRY: The LPA inspected the kitchen/food service area at 12:15PM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates and food labels had expiration date clearly marked. Knives and chemicals were locked and inaccessible in kitchen drawer and cabinet under the sink. At 12:22PM, LPA observed one (1) milk carton that expired 06/03/2025 and five (5) sauces/condiments (maple syrup, two soy sauce bottles, ketchup, and oyster sauce) that were opened and stored in the pantry but state to “refrigerate after opening.” Administrator immediately discarded the expired milk and stored the sauces at appropriate temperatures. LPA observed a laundry room accessed through the kitchen which is locked and inaccessible to residents in care. BEDROOMS: There are six (6) private resident bedrooms. There is one (1) staff bedroom that is being used by staff as a private living quarter. The staff room is accessed through an attached staff bathroom. All rooms have direct access to the outside. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, sufficient lighting, and equipped with functioning auditory exit alarms. Report Continued on LIC 809-C RESTROOMS: There are five (5) full bathrooms; two (2) are private bathrooms for resident use and two (2) are full bathrooms in the hallway that are designated for residents, staff, and guests. LPA observed resident restrooms equipped with grab bars and slip-resistant surfaces. Between 12:26PM-12:33PM, hot water temperature was measured in resident bathrooms and were between 105.4-106.2 degrees F, which is within the required range. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. The facility smoke alarm system is hard wired; the smoke and carbon monoxide detectors and fire doors were operable at the time of the visit. The fire extinguishers were fully charged and last serviced 12/06/2024. LPA observed required postings posted in the hallway and upon entry into the facility. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water on the premises. There is a self-latching gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. LPA observed a locked storage unit in the back yard containing additional supplies and yard equipment. MEDICATION REVIEW: At 12:40PM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in the medication room accessed through the kitchen/laundry. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs were properly documented and logged. No errors observed during the medication review. RECORD REVIEW: Beginning at 01:08PM, LPA reviewed five (5) out of five (5) resident files and three (3) personnel files for documents including but not limited to: medical records, resident Admission Agreement, TB test, staff training, first aid, and fingerprint clearance. All resident and personnel files were in order. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 05/05/2025. All documents reviewed were updated and in compliance. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct deficiency may result in civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.