Routine inspection·May 8, 2025

Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection. LPA arrived unannounced and explained the purpose of the visit LPA met with Andy and Yelly Kohler, who assisted with the inspection today. The facility is licensed for 6 residents ages 60 and over. The fire clearance is approved for Six (6) non-ambulatory residents. Currently there are zero (0) residents at the facility, three (3) residents have been re-located at facilities nearby and one (1) resident has gone home with family. The renovations to the facility for Eaton Canyon Fires caused smoke damage to the facility. Renovations for disaster readiness being implemented. LPA utilize the Compliance and Regulatory Enforcement tools for the visit today and observed the following: 1. Infection Control. Facility has sufficient PPE supplies and has an Infection Control Plan. 2. Physical Plant and Environmental . The facility is a single-story house. The facility includes living room, dining area, kitchen, four clients’ bedrooms, 2 shared bedrooms, 2 private bedrooms, two bathrooms. Laundry area and an detached garage. LPA inspected the carbon monoxide detector and is working probably. The smoke detectors are in each room and common area, and they are working, hardwired and interconnected. Water temperature in two bathrooms and kitchen, a 105 -120 deg F. All the sharp knives and utensils are locked in the kitchen cabinet. All the cleaning supplies and chemicals are locked in the laundry room and locked in the outdoor storage. The facility has sufficient personal hygiene products for clients to use. All clients rooms are currently furnished with chairs and have required beddings. All the bathrooms are clean, sanitized, and operational. The exit and passageway is safe and clear of obstructions. 3. Operational Requirements. The facility maintained a fire clearance approved by the fire department which 6 may be non-ambulatory. Currently all the clients in the facility are non-ambulatory. The facility also has shaded area with table and chairs for client to utilize for outdoor activity. The last fire/disaster drill was conducted on 06/07/2024. Currently there are zero (0) residents at the facility. Contined on 809C... 4. Staffing: The facility has sufficient staffing. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. All the direct care staff received Medication Management Training. The first aid training certificates for staff is current and expires 12/09/2026. Licensee/Administrator certificates for Yelly and Andrei Kohler good thru 05/15/2026. 6. Resident Records-Incident Reports: Resident files are maintained at residents’ current facilities the residents are temporarily located. 7. Resident Rights-Information: The Ombudsman and CCLD poster and Residents personal rights are posted in the hallway. 8. Planned Activities : Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: Currently the residents are temporarily placed in other facilities and are taking their meals. The kitchen was inspected food preparation area, and storage areas were observed to be very clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. 10. Incidental Medical & Dental: The medications are centrally stored, today no medications were reviewed. Residents are not present at the facility. 11. Disaster Preparedness: The facility has an Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, The facility conducts emergency drill on a quarterly basis for all staff and residents. Last safety drill was conducted on 06/27/24. Three (3) fire extinguishers located throughout the facility, purchased 01/28/2025. 12. Residents with Special Health Needs: No residents have prohibited health conditions. Facility dues were paid 05/07/2025. No deficiencies observed during today’s visit. An exit interview was held. A copy of this report was provided to licensee/administrator Andrei Kohler.