Routine inspection·March 10, 2025

On 03/10/2025 at 08:40 am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one year inspection. LPA met with Tina Cinco, Licensee and the purpose of the visit was discussed. Facility is licensed to age range 60 and over to serve six (6) non- ambulatory residents of which one (1) may be bedridden in Room 4 with a waiver/granted for hospice care for six(6) on 01.11.2024 by the department. Three (3) residents are diagnosed with dementia, two (2) residents are receiving home health, and two (2) hospice care services. The facility does not handle any of the residents’ money. The facility annual fees have been paid in full. The liability insurance is with James River Insurance (policy # 0091573-5) with each occurrence is $1,000,000 and general aggregate is $3,000,000 which is valid from 05/07/2024 - 05/07/2025. The home is a single story home consisting of: (4) resident bedrooms, (2) full bathroom, a living room, kitchen with dining area, a garage (attached with a laundry area, an additional refrigerator and pantry items), a backyard with a shed, an outdoor shaded patio area and additional sitting area outside. Between the hours of 9:28am - 9:45am, LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 120.4 (in bathroom #1), 118.0F (in bathroom #2) and 120.6 (in the kitchen). Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. LPA conducted a records review of (6) client records, (6) staff records, (6)Medication Administrator Records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was conducted on 02/01/2025 and in compliance with Title 22 at the time of visit. Report continues on LIC 809-C Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8); LPA observed the following de ficiencies: On 03/10/2025, between the hours of 09:28 am - 09:45 am while LPA was conducting a tour of the physical plant, and observed Resident #3 located in Room #3. Upon, LPA reviewing the facility records (facility sketch, fire safety inspection request), between the hours of 10:10 am - 11:24am, LPA observe the facility license states bedridden resident must be located in Room #4. An exit interview was conducted Tina Cinco (Licensee), and a copy of Report and Appeal Rights provided.