Routine inspection·August 13, 2025

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit on 8/13/2025 and was greeted by the two caregivers. LPA stated the purpose of the visit was to conduct an annual inspection. Staff confirmed there is one resident living in the facility. The facility is licensed for six non-ambulatory residents. Room 1 is for staff use only, Room 2 for two non-ambulatory, Rooms 3 & 4 for one non-ambulatory, and Room 5 for one bedridden and one non-ambulatory resident. LPA and the staff member toured the facility 10:20 am until 11:00 am. Living/Dining Room – LPA observed the living room and dining room are combined. The living room area consists of comfortable seating. The dining room contained a dining room table with chairs. LPA observed a wood stove insertion within a lower level fireplace. The area was surrounded by a metal fencing that was locked. Kitchen - The facility contained a seven day supply of non-perishable food and a two day supply of perishable foods. A locked kitchen cabinet contained resident medication containers and the first aid kit. The knives were locked in a drawer. A fire extinguisher is also located in the kitchen. The cleaning solutions were locked underneath the sink. Staff Room – The staff room was locked. Continued on 809-C Backyard - The backyard is a two level area which consists of a upper and lower area. The upper area is a shaded area which contains comfortable seating. The lower area is surrounded by a locked gated area in order to ensure the safety of the residents. The side gate leading from the backyard to the front yard was not locked. Bedrooms - There are four bedrooms (Room 2, 3, 4, and 5) which contained bed, linens, night stand, lamp, chest of drawers, and a chair. Bathrooms - There are three bathrooms which contained hand soap, paper towels, trash can, grab bars, and slip resistant mats. Garage - LPA observed four locked metal storage closets which contained additional hygiene items, non-perishable and emergency food items, and cleaning solutions. The washer and dryer are located in the garage. Water Temperature - LPA tested the water temperature at 10:50 am and was 122 degrees F. The hot water heater's temperature was adjusted. LPA tested the water again at 11:10 am and the water temperature was 111 degrees F. Smoke and Carbon Monoxide Detectors - The detectors were tested at 11:30 am and were operable. Resident Files - LPA spoke to the Administrator who stated the resident's file was not at the facility. Staff Files - LPA reviewed the staff files at 11:35 am until 11:50 am. Medications - LPA reviewed the resident medications at time. Pursuant to Title 22, California Code of Regulations, deficiencies will be cited (refer to LIC 809-D. Exit interview conducted, appeal rights discussed, and a copy of the report was given.