Routine inspection·September 30, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 11:22AM. LPA met with staff and Administrator Elaine Bote who arrived shortly thereafter. Entrance interview conducted. Beginning at 11:27AM, the LPA, along with staff and 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: KITCHEN: At 11:27AM, LPA inspected the kitchen/food service area. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility had a sufficient supply of perishable and non-perishable food. Knives, sharps, cleaning supplies, and disinfectants are stored inaccessible in a locked cabinet. BEDROOMS: There are six (6) single-occupancy resident bedrooms. All resident bedrooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: There are three (3) bathrooms, two (2) are in the hallway and one (1) is attached to Bedroom #3. LPA observed bathrooms to be clean, sanitary, and in operating condition with slip-resistant surfaces and grab bars. Hot water temperatures were measured in bathrooms and were between 114.3-117.7 degrees F, which is within the required range. Report Continued on LIC 809-C . COMMON AREAS: These include the living room and dining area. Common areas were appropriately furnished and in good condition. Smoke detectors and carbon monoxide detector were tested at 11:51AM and were operable. LPA observed two (2) fire extinguishers, one (1) by the laundry room which was fully charged and last serviced 09/10/2025 and one (1) in the kitchen area which was fully charged. Required posters were displayed throughout the common areas. OUTDOOR AREA: The backyard has patio furniture and a covered area. No obstructions observed in the passageways. No bodies of water were observed. There is an outdoor storage area which contained additional supplies and a staff break area. LPA observed a staff member sleeping in the storage area however interviews stated that staff have their own room and only utilize the storage area for breaks. MEDICATIONS: Medications review began at 11:54AM; medications are centrally stored and kept inaccessible in a locked kitchen cabinet. LPA reviewed medications for two (2) residents. At 12:15PM, LPA observed Trazadone 50mg for Resident #1 (R1) with four (4) pills unaccounted for. The centrally stored medication and destruction record (CSMDR) had the medication logged with a start date of 09/12/2025 and a quantity of 90 pills with directions to administer one (1) pill a day, however, a total of sixty-eight (68) pills were observed during the visit on 09/30/2025 instead of seventy-two (72) pills. Staff stated that the medication may have been incorrectly filled by the pharmacy and the quantity received may have been off, however, no documentation could be provided. RECORD REVIEW: LPA began record review at 12:55PM. LPA reviewed six (6) out of six (6) resident files for documents including, but not limited to: appraisals, medical records, admissions agreement, and consent forms. Four (4) out of six (6) resident files were missing updated appraisals. Administrator completed the reappraisals during the visit. LPA reviewed three (3) personnel files for documents including, but not limited to: personnel record (LIC 501), health assessments/screening (LIC 503), TB test, criminal record clearances, active first aid/CPR training, and appropriate training. LPA observed two (2) out of three (3) staff missing criminal record clearance, LIC501, and LIC503. During the visit, staff left to obtain criminal record clearance and Administrator stated that the two (2) staff will not resume work until receiving background clearance. Administrator stated that facility will have staff coverage. Report Continued on LIC 809-C . INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drill was conducted on 09/01/2025. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Civil penalty was issued in the amount of $1000 for criminal record clearance. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted. The report was reviewed during the visit. A copy of the appeal rights and report were provided via email and postal mail on 10/01/2025 for signatures due to technical difficulties during the visit.