Routine inspection·April 18, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:35 AM. LPA met with facility staff who contacted the facility Administrator Annie Osborn. The Administrator arrived to the facility at 10:07 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:08 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: 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. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed a fire extinguisher mounted on the wall to be purchased on 04/11/2025. The kitchen contained a locked cabinet that contained facility files and locked under-sink storage containing cleaning chemicals. OUTDOOR SPACE: The facility has two (2) emergency exit gates located on either side of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. Continued on LIC 809C. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage contains an extra refrigerator, the facility’s washer and dryer, laundry chemicals, care supplies, and adequate emergency food and water supplies. COMMON AREAS : This includes the living room, hallway, and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains a fireplace, it is appropriately screened and contains no tools. The hallway was observed to contain a storage closet which contained extra linens for resident use. The dining area was observed to be equipped with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:45 AM and were functional at the time of the visit. During the fire alarm test LPA observed the fire door leading to bedroom #4 to fail to close. LPA observed the fire door to be missing the magnetic latch and the self-closing mechanism to improperly installed rendering it non-functional. LPA informed the Administrator that this is a violation of the facility’s fire clearance and is a zero-tolerance violation. An immediate civil penalty in the amount of $500 will be assessed on today’s date (04/18/2025). The Administrator expressed understanding and confirmed that that a repairman would make necessary repairs to the door no later than 04/23/2025. The Administrator confirmed that the fire door will remain closed until repairs are completed. All exits in the facility were observed to contain functioning auditory alarms. BEDROOMS : There are four (4) bedrooms in the facility; two (2) are single occupancy resident rooms and two (2) are dual occupancy resident rooms. LPA and facility administrator toured all four (4) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms #3 and #4 contain direct exits to the outdoors of the facility. Continued on LIC 809C. BATHROOMS : There are two (2) bathrooms at the facility. One (1) designated as a private resident bathroom, and one (1) is designated as a shared/common resident bathroom. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. LPA observed one (1) sink in the common resident bathroom to be leaking water into the cabinet located beneath the sink. The Administrator confirmed that a repairman would be arriving to complete necessary repairs by end of day tomorrow (04/19/2025). The water temperature was initially measured to be between 137.8 and 140.0 degrees Fahrenheit, which is outside of the range required by regulation. The Administrator adjusted the temperature on the hot water heater during the visit. LPA tested the water temperature again at approximately 01:30 PM and measured the temperature to be 109.6 degrees Fahrenheit which is in compliance with regulation. RECORD REVIEW: Record review began at 11:06 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, consent forms, and personal rights. Two (2) staff files were reviewed. All staff files contained all required documents and trainings. Six (6) resident files were reviewed. Two (2) resident files were observed to be missing required signatures and documentation including consent forms, personal rights, and safeguards for property and valuables. MEDICATION REVIEW: Medication review began at 12:58 PM. Medications for three (3) of six (6) residents were observed. All medications were stored properly and were appropriately documented on their respective 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 it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/11/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. Continued on LIC 809C. INTERVIEWS: LPA interviewed three (3) residents. All residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. LPA interviewed two (2) staff members. Both staff members interviewed were knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies and civil penalty were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.