Routine inspection·August 27, 2025

On 08/27/2025 at 11:00am, 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 Anna Miranda (Administrator) and the purpose of the visit was discussed. The facility is licensed to serve residents age 60 and over and is approved for four (4) non-ambulatory and two (2) bedridden resident in room #2 and room 4 with a hospice waiver approval for six (6) residents. Two (2) of the residents are diagnosed with dementia, two (2) residents receive home health, one (1) of the residents is receiving palliative care and one (1) of the residents are receiving hospice care services. The facility does not handle any of the residents’ money. The facility has a current administrator certificate (7007725740) for Mark Cummings valid from 03/26/2025 - 03/25/2027. The facility fees are current. The facility has liability insurance with Primary Care Insurance, a Risk Retention Group, Inc (NAIC#16959) with each occurrence at $1,000,000 and general aggregate at $3,000,000 (policy #PCI10127373-02) effective date 05/04/2025 - 05/04/2026. The facility is a one-story house located in a residential neighborhood. The home consists of six (6) resident bedrooms, three (3) full bathrooms, a toilet room, a medication closet and cabinet, a kitchen, a dayroom, a laundry room, a office room, a patio area with shaded area, a pool with a surrounding fence and a attached garage with and an additional fridge and emergency supply. Report continues on LIC 809-C. Between the hours 11:05am - 11:41am, 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. The water temperature measured at 110.1 °F (in bathroom #1) and 111. 9°F (bathroom #2). Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards doorways were free of obstructions. Between the hours of 11:50am - 2:45 pm, LPA conducted a records review of (6) residents records, (6) staff records and (6) Resident Medication Administration Records and the facility disaster plan. The facility disaster conducted a disaster drill on 08/13/2025) and in compliance with Title 22 at the time of visit. 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 a body of water was observed (outdoor pool with a surrounding fence) . Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During today’s visit LPA observe a deficiency. LPA observed the following not in compliance: On 08/27/2025, between the the hours of 11:50am - 2:45pm, LPA conducted a records review and observed four (4) out of six (6) resident did not have a physician order for the half bedrails. See LIC 809-D page for deficiency. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did observe deficiencies, and citations were issued at this time. An exit interview conducted with Anna Miranda (Administrator) and a copy of this report was provided with Appeal Rights.