Routine inspection·August 19, 2025

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by the Wellness Director, Ken Patrick Padilla, and explained the purpose of the visit. The facility is licensed to serve (41) ambulatory and (34) non ambulatory residents age 60 and over, hospice waiver approved for ten (10) residents and non-ambulatory to be housed on the second floor only. There are currently (69) residents residing in the facility, of which five (5) are under hospice care and (0) bedridden. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance lobby. The facility has an Infection Control Plan in place. Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. The facility does not have a Dementia Waiver in place. A Hospice Waiver for (10) is approved, no bedridden allowed. There are 17 fire extinguishers in the facility which was serviced on 04/04/2025. LPA reviewed that the Liability insurance is in place. Fire and disaster drills were last conducted on 08/19/2025. Physical Plant/Environment Safety: The facility is a 3-story building located in a residential/commercial community. The facility consists of: First floor: Lobby, Administrative offices, (1) Elevator, Dining room, Kitchen, Pantry areas, Employee break room, Storage rooms, Covered parking area, Activity room, Boiler room and Electrical room. Physical Plant/Environment Safety [Cont.]: Second floor: (31) resident rooms, Activity room, Exercise room, Medication room, Business Office Manager's office, Wellness/Health Center, Beauty salon, Courtyard and Laundry room. Third floor: (34) resident rooms and Laundry room. The interior and exterior physical plant was inspected. LPA inspected eight (8) residents' rooms and each resident bedroom has the required furniture such as the bed, bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. The bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, skid matt/strips and shower chair. Exit doors are free of any obstruction and there are no pools or large bodies of water. LPA observed Emergency Chairs at the stairways. Carbon Monoxide and Smoke detectors are interconnected and were tested annually and working properly. Cleaning supplies and toxic substances are inaccessible to residents. LPA tested hot water temperature in eight (8) random resident rooms (Rooms: 103, 113, 115, 120, 201, 205, 207 and 219) in the 2nd & 3rd floors. Water temperature readings measured between 111.3 degrees F to 119.1 degrees F within the required 105 - 120 degrees Fahrenheit. Staffing: A total of (44) staff members provide care and supervision to the residents, including the Executive Director. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and are associated to the facility. Personnel Records-Training: Seven (7) staff files were reviewed which include: Personnel Record, health screening, TB test results, Employee Rights, valid First Aid / CPR/AED Training, staff training. Executive Director’s Administrator’s certificate is valid and expires on 02/18/2027. However, based on record review, the Executive Director, Staff #2 (S2), Staff #5 (S5), and Staff #6 (S6’s) file did not have the Health Screening and TB. Test. Resident Rights-Information: Resident personal rights, complaint hotline information and visitors’ policy posters are posted in the 1st floor hallway. Facility provides internet services to all residents and have access to the facility phone. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. LPA observed sufficient equipment and supplies to accommodate residents with special needs to meet the requirements of the activity program. Monthly & weekly activity calendar is distributed to the residents and posted in the elevator. Daily activity schedule is posted near the dining area. The facility has a Resident Council and council members/residents meet on a monthly basis. Food Service: Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept clean and stored properly. Sufficient food supply is stored in the kitchen and (2) pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are on file. Pesticides and cleaning supplies are kept away from the food preparation areas. Incident Medical and Dental: A total of eight (8) centrally stored resident medications were reviewed; containing 30-day supply of medications. Facility uses e-MAR (Point Click Care) system to properly document medications. Medications are bubble packed. A complete first aid kit is maintained in the medication room. Medical and dental transportation is provided. The first Aid kit was observed and has all required items. Resident Records/Incident Reports: LPA reviewed seven (7) resident files that include the Face Sheet, Identification and Emergency Information form, Admission Agreements, Physician's Reports, Pre Placement Appraisal, TB clearance, Personal Service Assessment, Physician's Orders, Ambulatory Status, and Personal Rights. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was last updated 06/07/2024 is in place with contact numbers and at least two (2) relocation sites. LPA observed the evacuation chairs at each stairway is in place. Residents with Special Health Needs: Four (4) residents are receiving home health services. Five (5) residents receive hospice care. Seven (7) residents are using oxygen and have "No smoking/oxygen in use" signs posted on the residents’ doors. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the as provided to the Wellness Director, Ken Patrick Padilla.