Routine inspection·March 11, 2025

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10:30a.m. Upon arrival, LPA Mosley was greeted by staff and called the Administrator to inform them of the visit. The Administrator arrived shortly after. The LPA met with Co- Administrators Elina Root and explained the reason for the visit. The LPA 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. INTERVIEWS : From 10:40 a.m. - 11:00 a.m. One (1) staff and three (3) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. COMMON AREAS : At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 1:46 p.m., smoke detector(s) and carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguishers were observed and fully charged on 2/21/2025. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 12/1/2024 and conducted quarterly with the next one scheduled this month. Activities were observed in the common areas. An adequate supply of emergency food and water was observed in the pantry adjacent to the kitchen. The facility has a working telephone on premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction. Inside temperature was maintained at a comfortable level. BEDROOMS: The facility is a single-story residential home with seven (7) bedrooms of which six (6) are for resident use and one (1) for staff use. Resident bedrooms are private, single occupancy with its own bathroom. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Staff room remains locked at all time. Report Continued on LIC 809C... Report Continued from LIC 809... BATHROOMS: The facility has a total of seven (7) bathrooms. Six (6) are private resident bathrooms and one (1) is a shared, common bathroom for resident use. Restrooms were clean and sanitary and in operating condition with grab bars and slip resistant surfaces. Hot water was measured in all resident bathrooms from 11:01a.m. - 11:20a.m. and measured between 121.1 - 124.1 degree Fahrenheit over the required range temperature of 105–120 degree Fahrenheit posing an immediate health and safety risk to persons in care. At the time of the visit the Administrator was able to adjust the water temperature and get it to the required range of 105–120 degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. KITCHEN: The LPA inspected the kitchen/food service area at 11:21 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 114.4 degrees Fahrenheit at 11:21 a.m. Cleaning solutions, toxins, chemicals, and hazardous items were inaccessible and locked away inside a kitchen cabinet under the sink. OUTDOOR SPACE/ GARAGE: The LPA observed the back yard which had two (2) portable outdoor umbrellas for shade along with patio furniture including tables and chairs for resident use. The LPA observed one gate that self-latches with a clear passageway in case of an emergency. There were no bodies of water observed on the premises at the time of the visit. The garage is kept locked and inaccessible to residents. LPA observed an extra refrigerator with extra food that was checked for proper labels and expiration dates. The laundry units were observed outside adjacent to the garage in its own covered area. LPA observed laundry detergent locked, inaccessible to residents stored in the garage. RECORDS : Records review began at 11:30 a.m., six (6) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records in order. At 12:40 p.m. six (6) Personnel records including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Report Continued from LIC 809C... Report Continued from LIC 809... Infection Control / Emergency disaster planning: During today’s visit LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate. MEDICATIONS: Medications review began at approximately 1:50 p.m. Medications are centrally stored and locked in a closet adjacent to the kitchen; Medications for five (5) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed. Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, and current Liability Insurance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.