Routine inspection·September 9, 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 Chile Shikabenga, Care Staff and explained the purpose of the visit. Administrator Linda McIntosh and House Manager, Brittney McIntosh arrived and assisted LPA with the inspection. The facility is licensed to care for six (6) elderly residents ages 60 and above, approved for (6) non-ambulatory residents and hospice waiver for (5) residents. 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 maintained. The facility has an Infection Control Plan in place. Bathroom has hygiene items such as hand soap and toilet paper. Paper towels are only provided in the bathroom. Facility uses cloth/reusable towels in the kitchen. Operational Requirements: LPA reviewed the Infection Control Plan in place. A fire clearance is in place. Last Fire Drill was conducted on 09/02/2025 and training conducted on a monthly basis. The administrator has valid liability insurance in place. Facility does not handle cash resources for the residents. The facility has working signal systems in exit points, which LPA along with the Administrator tested during the visit. Physical Plant/Environment Safety: The facility is a 2-story home located in a residential neighborhood, 1st floor consists of (4) resident bedrooms, (2) bathrooms, living room with screened fireplace, den/tv area with screened fireplace, kitchen, dining area, laundry area, detached garage, backyard with gated swimming pool, small storage building, shed, shaded patio area. The 2nd floor consists of an office area, staff sleeping quarter with curtains as a divider for privacy and (1) bathroom. Currently, there are five (5) residents living in the facility. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, bed with 1/2 and full bed rails, linen, dresser, light, chair and sufficient closet space. Beds and furnishings were all in good working condition. Extra linens and towels are in the hallway closet. Exit doors are free of any obstruction and there is a gated swimming pool in the backyard. Backyard was inspected and has a shaded area and sitting area. The fireplace is closed and inaccessible to clients. The laundry area is in the hallway. There is one (1) fire extinguisher that is fully charged in the kitchen and was last inspected on September 2025. Carbon monoxide was tested and operable. There are no firearms or weapons stored at the facility. Water temperature readings were measured at 114.6 deg in bathroom #1, 113.7 deg F in bathroom #2 which are within the 105 degrees F and 120 degrees F Title 22 regulation. Staffing: A total of seven (7) staff members including the Administrator provide care and supervision to the residents. 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: LPA reviewed four (4) staff files that include personnel records, health clearance, TB test results, criminal background fingerprint clearance, 1st Aid/CPR training, Employee Rights, and staff training. The administrator certificate is valid and will expire on 07/26/2027. Resident Rights-Information: Resident personal rights, complaint hotline information and visitors’ policy posters are posted. Per Administrator, facility provides internet services to all residents and have access to the facility phone. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Activities supply observed. Food Service: Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. There are sufficient food supplies of 2-day perishable and 7-day non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Plates, cups and utensils are kept clean and stored properly. Per administrator, there are no residents that have a modified diet. Incident Medical and Dental: Medications were reviewed for five (5) residents to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. Medications are bubbled packed and stored in a locked medicine cart. Resident Records-Incident Reports: LPA reviewed five (5) resident files. Resident files are maintained at the facility. Admission Agreement, I.D. and Emergency Information (Face sheet), Physician's Report (including TB and Ambulatory Status), Physician's order for bed rails, Admission Agreement, Appraisal and Needs Services plan, Pre-Admission Appraisal, Resident Personal Rights, and Resident Personal Property observed. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Evacuation chairs are in place. The facility has a First Aid Kit with all required items. Residents with Special Health Needs: Per Administrator, there are four (4) residents receive hospice services and no residents receives home health services. Half bed rails for mobility assistance were observed in some resident rooms and LPA reviewed resident files with half bed rail orders. No residents have prohibited health conditions. Per the California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today’s visit. Exit interview was held and a copy of the report was provided to Administrator Linda McInto.sh