Routine inspection (multi-day)·July 31, 2025

Licensing Program Analyst (LPA) Daniel Konishi conducted the unannounced required annual inspection. LPA met with the Business Office Manager, Carmen Hernandez and the purpose for the visit was explained. The facility is licensed for the age range 60 and over and 163 non-ambulatory residents. Currently, the facility has six (6) hospice waiver residents and seven (7) home health residents. The initial annual visit was conducted on 07/29/2025. During the initial visit the following eight (7) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant Environmental Safety, Resident Rights-Information, Planned Activities, Food Services, Incidental Medical and Dental, Disaster Preparedness. During today’s annual visit, the following five (5) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Operational Requirements, Staffing, Personnel Records-Training, Resident Records-Personnel Reports, Resident with Special Health Needs. Operational Requirement: T he current plan of operation is completed. The facility has a Dementia Waiver in place. A Hospice Waiver for 25 residents is approved. A fire clearance approved for 163 non-ambulatory residents. Based on record review, LPA observed that the facility has valid Liability Insurance in place. However, based on record review and observation, the facility has one (1) resident that is bedridden. Staffing: Facility has sufficient staffing for care and supervision for the residents. Personnel Record-Training: LPA observed ten (10) staff files which include: health screening, TB test results, personnel records, criminal record clearance, current First-Aid training certificates, medication assistance training, and other ongoing training. Administrator’s certificate expires on 3/3/2027. The Administrator has all the required training hours and staff has the required training hours annually. Based on record review, LPA observed that Staff #3 (S3), Staff #4 (S4), Staff #5 (S5) and Staff #6 (S6) did not have valid first aid training in file. Based on record review, LPA observed that Staff #1 (S1’s) file did not have an TB test result Resident Record-Incident Reports: LPA inspected fourteen resident files and they all have the required documents in file which include: Face sheet, Identification and Emergency Information, Pre-admission appraisal, admission agreement, recent medical assessment, ambulatory status, TB test result, appraisal/services and needs plan, and personal rights. Based on record review, LPA observed that Resident #6 (R6’s) file with Dementia did not have an updated medical assessment. Residents with Special Health Needs: Six (6) residents are receiving hospice services. Seven (7) residents receive home health services. No resident in the facility is on any postural support. No residents have prohibited health conditions. Immediate Civil Penalties is issued on today’s visit in the amount of $500.00 due to facility retaining one (1) bedridden resident (R13). Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the as provided to the Business Office Manager, Carmen Hernandez.