Routine inspection·September 2, 2025

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced at 11:33 a.m. to conduct a required annual inspection. The LPA was greeted by staff and informed them of the reason for the visit. The staff contacted the Administrator Justin Levi, and they arrived shortly thereafter. The LPA and the Administrator 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. COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The facility’s temperature was maintained at 77 degrees. The smoke detector and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was fully charged and was last serviced on 01/09/2025. The LPA observed required postings throughout the common space. KITCHEN: Knives are locked in a kitchen drawer stored inaccessible to residents in care. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured 118.0 degrees Fahrenheit. BEDROOMS: There are (6) resident bedrooms. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There was a linen closet in the hallway with extra towels and linens. Continues on LIC 809C ... BATHROOMS: The facility has three bathrooms. Two bathrooms are hallway shared bathrooms and one bathroom is a private bathroom located inside bedroom #1. All bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 115.0 degrees Fahrenheit. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. The washer and dryer are outside the facility. Detergent supplies are kept and locked in the laundry room. RECORDS: Records review began at 12: 36 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate annual training. One staff(S1) present at the facility did not have a file on site. Per the Administrator the staff was from an outside agency, and as a last-minute emergency/resort, due to a daily staff out for the day. MEDICATIONS: Medications review began at 1:45 p.m.; medications are centrally stored and locked in a cabinet in the kitchen area. Medications were audited and counted for accuracy of dispensing the medications. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability of 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. Citations were issued. Exit interview conducted. A copy of the report and Appeal Rights were issued.