Routine inspection·August 13, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:31 AM. LPA met with facility Administrator Mariana Romano. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:33 AM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: There are four (4) bedrooms in the facility; all four (4) are designated for resident use. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. All bedrooms were observed to contain direct exits to the outdoors of the facility. Bedroom #1 is the bedridden approved room. BATHROOMS: There are two (2) bathrooms at the facility. Both bathrooms are designated for resident use. Bathrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed near the resident toilet and in both resident showers and all were properly secured. The water temperature was measured between 105.6 and 108.1 degrees Fahrenheit, which is in compliance with regulation. LPA observed bathroom #1’s under sink cabinet to contain additional care supplies. Continued on LIC 809C. COMMON AREAS: This includes the living room, hallway, sunroom, and dining room areas. LPA observed the common areas to be clean and properly furnished at the time of the visit. The living room was observed to contain adequate seating for resident use. Additionally, the living room contained a television, activities, and a fireplace that was appropriately screened and contained no tools. The hallway was observed to be clean and free from any obstructions. The sunroom was observed to contain the facility’s emergency water supply and a cabinet that contained additional care supplies. The dining room was observed to be clean and contained adequate seating for resident use. Smoke detectors and carbon monoxide detectors were tested at 10:21 AM and were functional at the time of the visit. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. The LPA observed a locked drawer to contain knives and other sharp objects. LPA observed a secured cabinet to contain resident medications. LPA observed the under-sink cabinet to contain cleaning chemicals stored locked and inaccessible to clients in care. LPA observed a locked cabinet located adjacent to the kitchen to contain adequate emergency food supplies. LPA observed a wall mounted fire extinguisher to be fully charged and last serviced on 02/06/2025. OUTDOOR SPACE: LPA observed two (2) exit gates located on either side of the facility. LPA observed clear passageways for emergency exit use. The outdoors of the facility has adequate shaded seating for resident use. LPA observed the backyard to contain an appropriately screened pool that was locked and inaccessible to clients in care. LPA observed a secured shed that contained pool cleaning supplies. LPA observed cameras located on the outdoors of the facility. RECORD REVIEW: Record review began at 10:24 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Four (4) staff files were reviewed. All staff files contained all required documentation and trainings. Five (5) resident files were reviewed. Two (2) resident files were observed to be missing signatures on the inventory of resident’s personal property. One (1) resident file was observed to be missing a medical assessment and proof of a negative TB test. One (1) additional resident file was missing proof of a negative TB test. LPA informed the Administrator of the missing files and signatures. The Administrator agreed to obtain the missing documents and/or signatures and send copies of the completed documents to LPA. Continued on LIC 809C. MEDICATION REVIEW: Medications for 2 (two) of five (5) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheets. No deficiencies were observed during medication review INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. The last emergency disaster drill was conducted 06/03/2025. The facility’s emergency disaster plan is up to date and adequate. Both the infection control plan and the facility’s emergency disaster plan are reviewed/updated annually by the facility Administrator. INTERVIEWS: LPA interviewed one (1) staff and two (2) residents. Both residents stated that staff treat them well and are attentive to their needs. The staff member interview was conducted with the assistance of the Administrator acting as a translator. The staff member interviewed was knowledgeable on the resident rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s updated LIC500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, a copy of the report was issued, and appeal rights were provided.